Asian Journal of Medical Sciences

Avascular necrosis of skin flap post titanium mesh cranioplasty

Mon, 01 Apr 2024 00:00:00 +0000

Cranioplasty, the surgical restoration of cranial defects, has been a crucial procedure in neurosurgery for decades. Titanium mesh has emerged as a popular choice for cranial reconstruction due to biocompatibility and ability to confirm the patient’s unique cranial contours. While generally considered safe, titanium mesh cranioplasty is not without complications. This case report presents a challenging and atypical scenario of a patient who developed flap necrosis following titanium mesh cranioplasty. We aim to highlight the complexity of managing such cases and the importance of timely diagnosis and intervention.

Pancreatitis in pregnancy: The complex interplay with triglycerides and diabetes

Parisha Boda, Harshal Saxena, Nilay Suthar, Adityasinh Bhati — Mon, 01 Apr 2024 00:00:00 +0000

A rare and complex condition, severe gestational hypertriglyceridemia with acute pancreatitis in a primigravida poses a significant therapeutic challenge due to the absence of established guidelines. Many patients with hypertriglyceridemia exhibit concomitant insulin resistance, obesity, and fasting hyperchylomicronemia. This case report explores the successful management of a 20-year-old primigravida at 7 months of pregnancy presenting with severe gestational hypertriglyceridemia, diabetic ketoacidosis, and acute pancreatitis. Despite a lack of prior complications, the patient exhibited metabolic acidosis, hyperglycemia, hypertriglyceridemia, and acute kidney injury. A multifaceted approach involving insulin, statins, fenofibrate, antibiotics, and supportive measures resulted in improved lipid profiles and blood glucose levels. With induced labor and vaginal delivery, the intrauterine fetal death was addressed. The importance of routine lipid profile screening in high-risk pregnancies is underscored, emphasizing the need for early recognition and aggressive multidisciplinary management of severe metabolic complications in pregnant individuals with acute pancreatitis. This case stresses the critical role of a comprehensive approach for a successful outcome in such cases.

Efficacy of d-dimer level as a prognostic indicator in COVID-19 infection

Reshma S, Letha V, Deepa S, Sankar S — Mon, 01 Apr 2024 00:00:00 +0000

Background: Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2, was first reported in China in 2019 and later declared a pandemic. Coagulation abnormalities play the pivotal role in causing most of the symptoms related to COVId-19 infection. As the pathophysiology of COVID-19 is now being understood, it is found that these coagulation abnormalities, especially thrombosis are very well related to the severity of the disease. D-dimer is a potential biomarker for various thrombotic diseases. This study aims to determine the efficacy of D-dimer, Fibrinogen, Prothrombin time (PT), and activated partial thromboplastin time (aPTT) to determine the severity of COVID-19 infection.

Aims and Objectives: The objectives of the study are as follows: (1). To determine the efficacy of D-dimer in assessing the severity of the disease in COVID-19 infection. (2). To determine the role of PT, aPTT, and Fibrinogen levels in assessing the severity of COVID-19 Infection.

Materials and Methods: The study was conducted among 160 reverse transcription polymerase chain reaction confirmed COVID-19 patients admitted in Government Medical College, Kottayam. The sociodemographic profile and presenting complaints were obtained using a structured format. Blood samples were collected on the day of admission, the 5th day, and 10th day. Samples are tested for levels of D-dimer, Fibrinogen, PT, and aPTT. Based on the clinical outcome, patients were categorized into two groups: Mild group and severe group.

Results: The difference between the median D-dimer at admission in the severe group (1339 ng/mL) and the mild group (390 ng/mL) was statistically significant. Area under the receiver operating characteristic (ROC) for D-dimer was 0.774 and cut-off value was found to be 569 μg/mL with a sensitivity of 83.3% and a specificity of 61.2%. The ROC curve analysis, area under the curve of PT also can be used for diagnosis with 76.3% with 76.3% sensitivity and 61.2% of specificity.

Conclusion: Coagulopathy is an important complication of COVID-19 patients and is related to severity as well as prognosis of disease. D-dimer and PT can be used as reliable and convenient parameter for assessing coagulopathy and severity in COVID-19 infected patients.

The bifurcation level and geometric anatomy of abdominal aorta – Does it matter in cervical malignancy? Experience from tertiary cancer center

Mon, 01 Apr 2024 00:00:00 +0000

Background: The course, the origin of the branch, and the division of the aorta may vary and the aortic bifurcation level and branching can be determined by arteriogram, magnetic resonance imaging, computed tomography (CT) scan, and cadaveric dissection.

Aims and Objectives: This study aimed to find the variation in aortic bifurcation levels in cervical malignancy patients who underwent radiotherapy.

Materials and Methods: Between January 2018 and December 2022 previously untreated, histologically proven squamous cell carcinoma of the cervix patients who received radiotherapy in our department were selected for this retrospective analysis. A planning contrast-enhanced CT scan with a 3 mm slice thickness was done in a CT simulator to delineate the target volume and aorta, common iliac vessels in all patients.

Results: 407 cervical carcinoma patients who received radiotherapy in Linear Accelerator (LINAC) were included in this analysis. The aortic bifurcation is most commonly situated at the level of the L3–L4 intervertebral disc in 290 (71.25%) cases with a range between the upper L3 body and the lower L5 body. The common iliac bifurcation was situated at the level of L5–S1 in 338 cases (83.04%) and S1 vertebral body in 63 cases (15.47%). The average length of the left common iliac artery was 4.58 cm and the right common iliac artery was 4.44 cm. The diameter of the aorta at the level of just before the bifurcation is 1.39 cm. The average diameter of the left common iliac artery and right common iliac artery were 1.21 cm and 1.13 cm, respectively. The right and left take-off angles (αR, αL) are 25.58° and 23.78°, respectively.

Conclusion: The knowledge regarding the anatomic variation of branching and bifurcation of the aorta of utmost importance for surgical procedures, interventional radiology procedures, and proper radiotherapy treatment planning. Acknowledging these anatomic variations may also reduce complications.

Unraveling the anatomy of toe extensors: An aid to the clinical implications

Mon, 01 Apr 2024 00:00:00 +0000

Background: The extensor tendons of the foot are crucial for maintaining the intricate movements and stability of the foot and ankle complex. Understanding these variations is essential for health-care professionals involved in foot-related pathologies.

Aims and Objective: The study was conducted to identify and document variations in extensor tendons of the foot during routine dissection of human cadavers and to highlight their clinical significance.

Materials and Methods: This was an observational study conducted in the Department of Anatomy, King George’s Medical University, Lucknow, India. Eight embalmed cadavers were examined, and the dorsum of the foot was dissected to explore the proximal and distal attachments of extensor muscles.

Results: We observed unilateral variations in extensor tendons of the feet of three limbs during routine dissection. First case showed a bifurcation of extensor hallucis longus, giving tendons to great toe as well as 2nd toe. Second case showed a variation in extensor digitorum longus tendon of the 4th toe giving lateral and medial slips along with its main tendon. The medial slip further gave medial and lateral divisions to merge distally with the long tendons of 3rd and 4th toe, respectively. The third case depicted the bifurcation of extensor hallucis brevis to give tendinous slips to great toe and 2nd toe, respectively.

Conclusion: Knowledge of these variations in extensor tendons of foot is crucial for accurate interpretation of diagnostic imaging, surgical planning, and optimizing treatment outcomes.

Comparison of nalbuphine and morphine as intrathecal adjuvant to 0.5% bupivacaine for post-operative analgesia in lower abdominal surgeries – A randomized and control study

Subha Devanathan, Ilango Ganesan, Rangarajan R, Divya Devanathan — Mon, 01 Apr 2024 00:00:00 +0000

Background: The use of a higher volume of 0.5% bupivacaine, however, is associated with hemodynamic instability. Adjuvants such as morphine and other opioids are added in with the local anesthetic to reduce this adverse effect and extend the duration of sensory block, hence extending the length of analgesia. However, opiates are associated with a high risk of respiratory depression and other side effects. Nalbuphine has been used to counteract these adverse effects. Thus, we decided to compare the analgesic effect of intrathecal (IT) nalbuphine with IT morphine.

Aims and Objectives: The aim of the study was to compare IT morphine with nalbuphine as adjuvant to a spinal anesthetic agent. The primary objective was to compare between the time of onset of sensory and motor blockade and the post-operative analgesic duration between the two adjuvants, while hemodynamic variables and side effects were studied as secondary variables.

Materials and Methods: This randomized controlled study was conducted after Ethical Committee approval for a period of 1 year on 100 patients who fulfilled the inclusion criteria. They were randomized into two groups to receive sub-arachnoid block: Group A: 3 mL of 0.5% Hyperbaric Bupivacaine and 0.2 mg morphine and Group B:3 mL of 0.5% Hyperbaric Bupivacaine and 0.5 mg nalbuphine. The following parameters were monitored – Height, Weight, blood pressure, American Society of Anesthesiologists grading, time of onset, maximum duration and regression of Motor and sensory blocks, and total duration of analgesia.

Results: The onset of sensory blockade was comparable in both groups while the onset of motor blockade was significantly longer in the morphine group (P≤0.001). The duration of analgesia in the morphine group was longer as compared to nalbuphine group and was statistically significant (P<0.05). The incidence of side effects was 26% in the morphine group and 6% in the nalbuphine group, which was statistically significant (P<0.05). Fourteen patients in the morphine group had pruritus and four patients in the nalbuphine group experienced nausea.

Conclusion: IT nalbuphine with 0.5% bupivacaine produces rapid onset of anesthesia and early post-operative analgesia with minimal side effects, but the total analgesic duration was more with IT morphine.

A comparative study between 0.5% ropivacaine with 50 mcg of dexmedetomidine and 0.5% ropivacaine with 8 mg of dexamethasone for ultrasound-guided supraclavicular brachial plexus block – A randomized controlled study

Narasimhan MK, Renganathan T, Muralidaran S, Rajaram Jayaraman — Mon, 01 Apr 2024 00:00:00 +0000

Background: Peripheral nerve block analgesia is augmented using dexamethasone with perineural local anesthesia.

Aims and Objectives: The study aimed to assess and compare the effects of dexmedetomidine and dexamethasone on the onset and duration of the sensory and motor block when added to 0.5% ropivacaine for the supraclavicular brachial plexus block.

Materials and Methods: This randomized controlled study was conducted at the Department of Orthopedics, Government Stanley Medical College and Hospital, Chennai, for 6 months March 2021–September 2021). Eighty patients were randomly allocated into two groups. Group A (40 patients) received ultrasound-guided supraclavicular brachial plexus block with 0.5% ropivacaine (30 mL)+dexmedetomidine 50 mcg (0.5 mL)+normal saline (1.5 mL). Group B (40 patients) received ultrasound-guided supraclavicular brachial plexus block with 0.5% ropivacaine (30 mL)+dexamethasone 8 mg (2 mL).

Results: The dexmedetomidine group had a significantly faster onset of sensory anesthesia (3.9 min) than the dexamethasone group (7.8 min), with a higher duration. The dexmedetomidine group also had a faster onset of motor anesthesia (4.9 min) and a longer duration of analgesia (892.3 min) compared to the dexamethasone group (538 min). The dexmedetomidine group also had a longer duration for rescue analgesia (906 min) than the dexamethasone group (727 min). Visual Analog scores at 10, 14 and 24th h were lower in the dexmedetomidine group than in the dexamethasone group, which is statistically significant (P<0.001).

Conclusion: Dexmedetomidine has a faster onset, longer duration, longer analgesia, and prolonged duration for rescue analgesia compared to dexamethasone for ultrasound-guided supraclavicular brachial plexus block, with bradycardia and sedation as side effects.

Comparative evaluation of intraligamentary injection and traditional inferior alveolar nerve block in endodontic management of mandibular molar with symptomatic irreversible pulpitis: A randomized double-blinded clinical trial

Deepashri Tekam, Chetana S Makade, Pratima R Shenoi, Mohit K Gunwal — Mon, 01 Apr 2024 00:00:00 +0000

Background: Intraligamentary anesthesia (ILA) injection using a single-tooth anesthesia (STA) system has been used as a supplementary technique for pulpal anesthesia in cases of irreversible pulpitis.

Aims and Objective: The current clinical trial was undertaken to assess and compare the effectiveness of the conventional inferior alveolar nerve block (IANB) and the ILA technique utilizing the STA system for endodontic management of mandibular molars presenting symptomatic irreversible pulpitis.

Materials and Methods: Patients diagnosed with symptomatic irreversible pulpitis inmandibular molar were allocated into two groups: Group I IANB (n=30) and Group II- STA system (n=30). The onset of anesthesia was evaluated using the electric pulp test, whereas for pain perception the Heft-Parker Visual Analog Scale score was recorded before, during, and after anesthesia. Post-anesthetic pain was recorded at 3 h, 24 h, and 1 week. The collected data was evaluated for effectiveness pain perception, and acceptability of the anesthetic technique, using appropriate statistical tests.

Results: The mean time of onset for the Group II STA system (2.93±1.80) was significantly higher (P=0.0001) than Group I IANB (1.40±0.86). Pain at the site of injection was insignificant (P>0.05) between both groups. The severity of pain during the root canal procedure was significantly different (P<0.0001) in both cohorts. For both groups, the patient’s acceptance of the anesthetic procedure was statistically insignificant (P=0.21).

Conclusions: The STA system reported similar effectiveness in terms of effectiveness, pain perception, and acceptability of anesthetic technique when compared to IANB. Hence, the primary anesthetic treatment for conducting endodontic procedures on molars with symptomatic irreversible pulpitis appears to be the utilization of the ILA-employing STA system.

Efficacy and safety during endoscopic retrograde cholangiopancreatography (ERCP) under total intravenous anesthesia – propofol alone versus propofol supplemented with dexketa, a comparative study in medical college, Kolkata

Mon, 01 Apr 2024 00:00:00 +0000

Background: Endoscopic retrograde cholangiopancreatography (ERCP) is an invasive procedure and, hence, is distressing for awake patients, requiring an adequate level of anesthesia. Recent advancements have encouraged the use of monitored anesthesia care, that allows the patient to tolerate unpleasant experiences during procedures while maintaining cardio-respiratory function. Usually, propofol-based anesthesia is given in ERCP. The main aim of this study is to compare the effect of propofol alone and propofol with ketamine and dexmedetomidine on the hemodynamics during ERCP, recovery profile, and side effects (if any).

Aims and Objectives: (1) To compare efficacy in terms of hemodynamic stability and desaturation events. (2) Recovery and quality of recovery. (3) Pain score. (4) Incidence of post-operative nausea and vomiting.

Materials and Methods: This is a comparative double-blinded study. Adult patients from the age group of 18–70 years belonging to the American Society of Anesthesiologists (ASA-I) and ASA-II who had undergone ERCP under total intravenous anesthesia were taken and randomly assigned to either of the two groups. Both groups received 0.01 mg/kg glycopyrrolate, 0.1 mg/kg ondansetron, 0.05 mg/kg midazolam, 50 mcg fentanyl, and 40 mg hyoscine. Group A patients received 30 mg propofol as a bolus dose and then repeated according to requirements. Group B patients received 0.5 mcg/kg dexmedetomidine as a loading dose and 0.3 mcg/kg/h as a maintenance infusion dose. 30 mg propofol was given before negotiating scope and then 1 mL (1:1) mixture of propofol and ketamine was repeated according to requirements. Total propofol consumption, hemodynamics, quality of recovery, and side effects (if any) were recorded at regular intervals.

Results: The study showed significant cases in Group A had episodes of hypotension and apneic events, whereas there were very few hemodynamic instability and almost no apneic events in Group B patients. The requirement of propofol was much higher in Group A patients.

Conclusion: Dexmedetomidine when used along with propofol and ketamine in ERCP patients reduced the dose requirement of propofol and maintained hemodynamic stability without causing any apneic events.

Comparison of hemodynamic response of intravenous lidocaine and esmolol during laryngoscopic intubation under general anesthesia for major abdominal surgery

Manpreet Singh, Maitraye Basu, Amrita Ghosh, Ranabir Pal, Manasij Mitra — Tue, 02 Apr 2024 00:00:00 +0000

Background: Many studies have shown the beneficial effect of prophylactic lidocaine or esmolol on hemodynamic response during laryngoscopic intubation. Although many studies observed a better effect of esmolol over lidocaine, some studies have drawn an impression of equal efficacy or even no benefit with the use of either of the drugs.

Aims and Objectives: The study aimed to compare the heart rate (HR) at 1 min after intubation between the patients receiving lidocaine and esmolol. Other outcome measures were to compare HR at 3 and 5 min post-intubation and to compare the mean arterial pressure at 1, 3, and 5 min after intubation. In addition, the adverse events, if any, were noted.

Materials and Methods: Fifty patients, 30–45 years, either sex, Mallampati grade 1–2, of the American Society of Anesthesiologists physical status I-II, posted for elective abdominal surgery requiring direct laryngoscopic endotracheal intubation were included. Patients were randomly allocated into two groups to receive esmolol 2 mg/kg (Group E, n=25) or 2% lidocaine 2 mg/kg (Group L, n=25), intravenously. HR and mean arterial blood pressure (MAP) were recorded at 1-, 3-, and 5-min interval post-intubation.

Results: The mean HR at 1-min post-intubation was considerably lower using esmolol in comparison with lidocaine (91.7±9.7 vs. 107.7±5.1, P≤0.0001). The mean HR and MAP at 3-min and 5-min post-intubation were considerably lower with the use of esmolol compared with lidocaine.

Conclusion: Esmolol is better than lidocaine in attenuating the hemodynamic response of intubation.

Perioperative analgesic management in patients with bladder exstrophy: A clinical study

Monika, Prakriti, Mohit Jain, Kiranpreet Kaur, Karishma Dhankhar, Sahil Turkia — Mon, 01 Apr 2024 00:00:00 +0000

Background: Bladder exstrophy is a complex, rare congenital malformation with an incidence of 3.3 cases in every 100000 live births and is slightly more common in males. Primary surgical repair requires many hours of surgery with fluid and blood loss. Because of wide fluctuations in hemodynamics, a longer duration of surgery, smaller age, risk of hypothermia and post-operative intensive care may be required. We evaluated the use of continuous caudal epidural infusion of bupivacaine and fentanyl under general anesthesia for urinary bladder exstrophy-epispadias surgery in children.

Aims and Objectives: Aim of the study was to evaluate the postoperative analgesia in patients undergoing surgery for bladder exstrophy. The primary objective was to assess the postoperative pain using FLACC scale and sedation score after successful caudal administration. Secondary objective was to assess the hemodynamic changes after caudal administration.

Materials and Methods: A total of 13 patients aged between 9months and 13 years of either sex, weighing between 5kg to 30kg, belonging to ASA grade II to IV, underwent surgery for epispadias–exstrophy complex. Initial bolus 0.75ml/kg of 0.25% bupivacaine with fentanyl 1ug/kg was given through epidural. Postoperative analgesia was maintained by continuous infusion of 0.0625% bupivacaine @0.1ml/kg/hr in young children and 0.125% bupivacaine with fentanyl 1ug/ml in older children for 4-5 days with the help of ON-Q pump or infusion pump. Baseline hemodynamic parameters including MAP, heart rate and SpO2 was recorded at various time intervals. Postoperative pain was assessed using face, legs, activity, cry and consolability (FLACC) pain scale and sedation score was assessed by using ramsay sedation score.

Results: There was a statistically significant decrease in mean pulse rate in the study group from baseline to thirty minutes after reversal (p<0.001). Similar observation was made for mean arterial pressure which also showed statistically significant decrease from baseline to thirty minutes after reversal (p<0.001). No change was observed in SpO2 from baseline to any other follow-up interval.

Conclusion: Perioperative anesthetic and analgesic management of the bladder exstrophy patient can improve the success rate. Epidural bupivacaine with or without fentanyl infusions for short duration can provide safe analgesia.

Oral supplementation of Njansan (Ricinodendron heudelotii Bail) and sardine fillets (Sardina pilchardus) oils alleviate high-fat diet-induced obesity in rats by regulating lipid metabolism and stress oxidative parameters

Soh Nde Florent, Ghomdim Nzali Horliane, Ejoh Aba Richard, Tchiegang Clergé — Mon, 01 Apr 2024 00:00:00 +0000

Background: Obesity has become one of the most common metabolic disorders in the world, characterized by the accumulation of excess fat in the body. Research into natural compounds to improve obesity has become increasingly important.

Aims and Objectives: The aim of the study was to explore the effects of Sardina pilchardus and Ricinodendron heudelotii oils on the management of obesity.

Materials and Methods: Njansan (R. heudelotii) oil was extracted by cold pressing using an automatic oil press machine and Sardine fish oil by a cooking method. To evaluate the anti-obesity effect of these oils, six groups of six male Wistar rats were fed different diets: C0 group received a normal diet; HFD was fed a high-fat diet; N1, N2, F1 and F2 followed by a high-fat diet supplemented with njansan and sardine oils at 1 g/kg body weight/day and 2 g/kg body weight/day, respectively.

Results: There was an increase in body weight, relative abdominal fat, and liver weight in the HFD group compared to the control group. There was also a decrease in anthropometric parameters such as the Lee index of the HFD group treated with njansan and fish oils, regardless of the concentration. The hyperlipidemic state in the HFD-fed rats was then normalized after treatment with both oils as well as hyperglycemia compared to the control group. Besides, fish and njansan oils attenuated HFD-induced oxidative stress, as indicated by a significant increase CA and superoxide dismutase.

Conclusion: This study demonstrated that njansan oils at a low daily dose (1 g/kg body weight) can be helpful in managing obesity and also reduce the risk of developing coronary heart diseases.

Silymarin-choline combination versus ursodeoxycholic acid in non-alcoholic fatty liver disease: A randomized double-blind clinical trial

Mon, 01 Apr 2024 00:00:00 +0000

Background: Non-alcoholic fatty liver disease (NAFLD) is an influential cause of liver disease burden. However, there is no evidence-based standard of care. Considering that oxidative stress and diet deficiency of choline plays a role in the pathophysiology of hepatic damage, natural compounds such as silymarin, choline, and ursodeoxycholic acid (UDCA) represent popular therapeutic options.

Aims and Objectives: The present study aimed to compare the efficacy, safety, and adherence of the silymarin-choline combination and UDCA in patients with NAFLD.

Materials and Methods: A double-blind parallel arm study where 88 NAFLD-diagnosed patients were randomized to receive either silymarin-choline bitartrate or UDCA for 6 months, along with lifestyle modification recommendations. Weight, body mass index, liver enzyme levels, lipid profile parameters, homeostatic model assessment of insulin resistance, liver stiffness measurement, and liver biopsy were monitored at baseline and 6 months. Adverse events and adherence were monitored.

Results: A total of 39 patients received a tablet of silymarin-choline bitartrate, while 40 received UDCA. A significant improvement was observed in aspartate aminotransferase (U/L) levels from 54.18 (17.02) to 37.23 (9.94) (P=0.000), NAFLD activity score from 6.5 (0.37) to 2.7 (1.26) (P=0.000), and transient elastography (kilopascal) scores, more in patients receiving the silymarin-choline combination, whereas for those receiving UDCA, a significant improvement was observed in total cholesterol (mg/dL) from 187.88 (27.49) to 171.45 (28.47) (P=0.000) and low-density lipoprotein levels. No major safety issues were observed in both groups.

Conclusion: NAFLD is currently treated by treating associated comorbidities, which cannot always stop its progression. Silymarin-choline bitartrate can be used as a better alternative to UDCA for the treatment of NAFLD.

Association of inflammatory markers, serum ferritin and high sensitive C reactive protein, with HbA1c and dyslipidemia in male patients of type 2 diabetes mellitus

Ravi Kant, Shashi Kala Kumari, Rakesh Sinha, Ranjeet Kumar, Arun Kumar — Mon, 01 Apr 2024 00:00:00 +0000

Background: Diabetes mellitus (DM) is a common metabolic disorder affecting insulin secretion, insulin sensitivity, or both, resulting in hyperglycemia. As it progresses, almost all systems including cardiovascular, nervous, renal, etc. are involved eventually manifesting as several health-related complications. As all the systems of the human body work in harmony with each other, development of insulin resistance, dyslipidemia, and setting in of chronic inflammatory states evidenced by the rise in inflammatory markers are interrelated.

Aims and Objectives: The aim of this study was to establish the correlation of the inflammatory markers, serum ferritin and high sensitivity C-reactive protein (hs-CRP), with glycated hemoglobin (HbA1c) and dyslipidemia in patients of type 2 DM.

Materials and Methods: The present cross-sectional study was carried out in the Department of Biochemistry, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand. A total of 80 male patients of type 2 DM aged between 40 and 60 years with blood HbA1c level of more than 6.5% were included in the study.

Results: The inflammatory markers hs-CRP and ferritin were found to be positively correlated with HbA1c, triglycerides, total cholesterol, and low-density lipoprotein-cholesterol but negatively correlated with high-density lipoprotein-cholesterol.

Conclusion: Estimation of serum ferritin and hs-CRP can detect the ongoing inflammatory and free radical-mediated damages in diabetic patients at an early period before the development of diabetic-related complications such as atherosclerosis and myocardial infarction.

Beyond cholesterol: Exploring serum ferritin’s and high-sensitivity C-reactive protein role in cardiovascular risk

Veena Murthy Goda, Pramodini Garikipati, Jyothi Nunna — Mon, 01 Apr 2024 00:00:00 +0000

Background: Iron, a pivotal element in the oxidation of low-density lipoprotein (LDL) cholesterol, exerts influence on inflammatory responses and exhibits a positive association with coronary heart disease. Elevated levels of the inflammatory marker, C-reactive protein (CRP), serve as a predictive risk factor for subsequent cardiac events.

Aims and Objectives: This study explores the interplay between cardiovascular disease risk factors and serum ferritin concerning CRP.

Materials and Methods: A cohort of 750 subjects (375 males and 375 females) was subjected to analysis. Elevated levels were defined as CRP >3.0 mg/L, serum ferritin >200 ng/mL, total cholesterol >200 mg/dL, and LDL-cholesterol >160 mg/dL. HDL cholesterol levels below 40 mg/dL were categorized as low.

Results: Within the low LDL-cholesterol group, no discernible correlation was observed between serum ferritin and high-sensitivity CRP (hsCRP) (odds ratio [OR] of 54.95, 95% confidence interval [CI] = 0.81–3.48, P<0.148). Conversely, a correlation was identified in the elevated LDL-cholesterol group (OR of 10.98, 95% CI=1.12–111.22, P<0.05). Furthermore, the introduction of an interaction term in the assessment of the correlation between elevated hsCRP and LDL-cholesterol reaffirmed a robust correlation between hsCRP and serum ferritin (P<0.005).

Conclusion: The oxidation of LDL-cholesterol by serum ferritin emerges as a potential contributor to inflammatory reactions and heightened hsCRP levels. Prospective studies are warranted to investigate whether interventions targeting the reduction of serum ferritin and CRP levels, through medical interventions and lifestyle modifications, could prove efficacious in preventing cardiovascular diseases.

A comparative study of ferric carboxymaltose and iron sucrose as a parenteral iron treatment in iron deficiency anemia during pregnancy in a tertiary care hospital

Sandip Kumar Ghosh , Raston Mondal , Sutapa Mandal , Arindam De — Wed, 03 Apr 2024 00:00:00 +0000

Background: Anemia from the Greek word (anhaima) meaning “without blood” is the deficiency of red blood cell and/or hemoglobin which result in reduced oxygen-carrying capacity of blood causing tissue hypoxia.

Aims and Objectives: To study the efficacy and safety of intravenous ferric carboxymaltose (FCM) versus iron sucrose in the management of iron deficiency anemia in pregnancy.

Materials and Methods: A prospective, single-center, comparative interventional randomized study was carried among 180 antenatal mother admitted to antenatal ward in the Department of Obstetrics and Gynaecology of Burdwan Medical College and Hospital, from July 1st, 2020, to December 30th, 2021.

Results: A total of 180 patients, 90 patients in each FCM and iron sucrose group, were included in the study. There was significant (P=0.001) mean change in hemoglobin (Hb) level in both the groups from pre-treatment to 3 and 6-week post-treatment. There was also a significant (P=0.001) mean change in ferritin level in both the groups from pre-treatment to 3 and 6-week post-treatment. The mean change in Hb level and ferritin level was higher among patients of FCM compared to iron sucrose. The adverse reactions were lower among patients of FCM than iron sucrose.

Conclusions: This study found that FCM is safer than iron sucrose. Treatment with FCM resulted in rapid replenishment of iron stores in pregnant women with significantly high rise of Hb and ferritin levels over a 6-week period with lesser adverse effects.

Prevalence of imposter phenomenon and its correlates among undergraduate medical students of a government medical college, West Bengal, India

Mon, 01 Apr 2024 00:00:00 +0000

Background: The prevalence of imposter phenomenon (IP) is more among students, engineers, health-care-professionals, and researchers. Medical students are particularly predisposed to IP due to stressors like a highly competitive environment both preceding and during medical education.

Aims and Objectives: The aims and objectives of the study are to find out the prevalence of IP among undergraduate medical students of a Medical College of Eastern India and to elicit the relationship between background factors and IP.

Materials and Methods: One hundred and thirty medical students were selected by stratified random sampling from all four semesters. Twenty point Clance IP scale was used to measure IP. It contains 20 questions, each of them having five options. A score between “60 and 80” indicates frequent imposter syndrome and a score higher than 80 indicates intense imposter feeling. After conducting descriptive analysis, ordinal logistic regression was conducted.

Results: Among the study subjects 37.7% had frequent imposter feelings and 10.8% had intense imposter feelings. High level of IP (frequent and intense combined) is more common among second-semester students, females, middle class, those who sleep >56 h/week, who perceived their school performance was good, who have a family history of psychiatric illness, and who take some kind of chronic medication. As per Ordinal regression, second-semester, middle class, good school performance, and history of chronic medication were found to be significant predictors of higher degree IP.

Conclusion: The prevalence of IP is alarming among medical students and it is high time to address this before it turns into graver psychiatric morbidity.

Demographic correlates, lifestyle habits, and health effects of poor sleep quality in Indian adolescent girls living in a second-tier city

Suganya Rajendran, Akhilendra Singh Parihar, Monica Lazarus — Mon, 01 Apr 2024 00:00:00 +0000

Background: Insufficient sleep, poor sleep quality, and sleepiness are common problems related to learning, memory, and school performance. During puberty, sleep habits change earlier among girls in parallel to their earlier pubertal maturity. The changes occur during adolescence in response to maturational changes and increased autonomy and independence.

Aims and Objectives: This study aims to estimate the prevalence of poor sleep quality among adolescent girls in a second-tier city.

Materials and Methods: Cross-sectional observational study conducted in 150 school-going adolescent girls from three different schools in a second-tier city. The study was conducted using the Pittsburgh Sleep Quality Index scale for assessment of the quality of sleep and an investigator designed pro forma to analyze various lifestyle habits. Kutcher Adolescent Depression Scale 6 was used to address the depressive symptoms.

Results: Prevalence of poor sleep quality was 9.2%. Pre-bed screen time of >30 min was found in 53% of girls with poor sleep quality. Overweight girls also have poor sleep quality. Good grades (>90% marks in examinations) were associated with poor sleep quality. About 8.3% of girls with poor sleep quality have one or more symptoms pertaining to depression.

Conclusion: The pre-bed screen time of more than 30 min in the form of any electronic screens leads to poor sleep quality and poor sleep quality is significantly associated with being overweight. Poor sleep quality is also associated with some symptoms of depression. These all are observed in the girls living in a tier two city, awareness among adolescent girls must be spread to decrease the screen time and they should also be encouraged for better sleep hygiene.

A comparative study of the outcomes of ribbon gauze and merocele methods of nasal packing after septal surgery

Ritam Ray, Ashim Sarkar, Tarun Kumar Mondal, Rajarshi Sannigrahi — Mon, 01 Apr 2024 00:00:00 +0000

Background: Septal surgery is one of the most commonly performed procedures in Otolaryngology. Following septal surgery, nasal packing is administered to prevent potential postoperative complications, including septal hematoma, hemorrhage, and synechiae formation. Nasal packing is commonly done using either ribbon gauze or non-absorbable materials like Merocele (Medtronic Xomed Inc., Jacksonville, FL, USA).

Aims and Objectives: The objective of the study is to compare the post-operative outcomes of ribbon gauze packing and merocele packing.

Materials and Methods: The study was a prospective observation study, conducted in Burdwan Medical College and Hospital from August 2023 to October 2023. The study population was 40 with equal distribution between the two groups. Patients older than 18 years undergoing only septal surgery are included in the study. All the surgeries are performed by the same surgeon, both packs are removed after 48 h and followed up with diagnostic nasal endoscopy (DNE) after 1 month. Statistical analysis was done using SPSS version 22.0 (IBM Inc., US).

Results: The total number of patients in our cohort was 40, out of which 20 were given ribbon gauze packs (Group A) and the rest were given merocele packs (Group B). The mean visual analog scale score for nasal pain (4.25±1.77), headache (4.30±1.63), dysphagia (2.50±1.15), sleep disturbance (3.15±1.09) in Group B was significantly lower than in Group A (6.65±1.63, 5.40±1.70, 4.00±1.84, and 5.40±2.35 respectively, p all<0.05). The mean of the postnasal drip score was lower in Group B, though that did not reach statistical significance (2.75±1.070 vs. 3.25±1.650, p=0.264). There were no significant differences between the two groups with respect to the age of the patients, gender distribution, or the presence of synechiae, granulation tissue, or signs of infection on DNE.

Conclusion: Although both the merocele and ribbon gauze packs can be suggested for use after septal operations, the merocele pack has the benefit of producing much less morbidity. Merocele cost is a major constraint at present so we should try to develop a similar nasal pack with less cost to benefit the maximum population.

Clinicopathological profile and its association with endoscopic findings in dyspeptic patients in a tertiary care hospital: A cross-sectional study

Aarthik Shetty, Yeshavanth G, Siddesh G, Nikhil Kumar DG — Mon, 01 Apr 2024 00:00:00 +0000

Background: The prevalence of dyspepsia in general practice consultations ranges from 4% to 5%, whereas it accounts for approximately 20–40% of consultations in the field of gastroenterology.

Aims and Objectives: This study was carried out with the objective of estimating the percentage of Helicobacter pylori-infected people who havedyspepsia and exploring the relationship between infection and clinical manifestation.

Materials and Methods: This was a hospital-based observational study conducted at a tertiary care teaching health-care facility from January 2023 to June 2023. All 50 patients with symptoms of dyspepsia were included in the study with the help of non-probability purposive sampling after their written and informed consent. A pre-designed and pre-tested structured pro forma was used to collect detailed history, clinical findings, and endoscopic findings from patients with dyspepsia. Gastritis and ulceration characteristics were observed by endoscopy, while histopathological examination (HPE) and rapid urease test (RUT) (for confirmation of H. pylori) were performed on endoscopy-obtained biopsy specimens.

Results: Mean age of the patients was 46.69±15.78 with 65.4% (n=34) being males. The sample was classified into cases positive for H. pylori (13; 25%) and cases negative for H. pylori (39; 75%), according to the RUT outcome, 21.20% (n=11) had a history of smoking, 25% (n=13) had Type II DM, and 25% of patients presented with upper abdominal bloating and epigastric pain. On endoscopy, the majority of patients revealed grade III (n=22, 42.30%) gastritis and no ulceration (n=29, 55.80%), with the maximum showing a chronic non-specific lesion (n=20, 38.5%) on HPE. Comorbidities (χ2=12.56, P=0.028), endoscopic findings (χ2=10.50, P=0.032), and ulcerations (χ2=20.02, P<0.001) were the significant findings associated with H. pylori infection.

Conclusion: The timely identification and expeditious management of H. pylori infection are imperative to mitigate the occurrence of severe complications.

Prevalence and feto-maternal outcomes of subclinical hypothyroidism in pregnancy among mothers attending a tertiary care hospital of Darjeeling District, West Bengal, India

Tanmoy Das, Nilratan Das, Sohan Bhowmick, Arunava Biswas — Mon, 01 Apr 2024 00:00:00 +0000

Background: Pregnancy is a stressful test for the mother’s thyroid function. The frequency of hypothyroidism in pregnant women is high. However, there are no adequate studies to evaluate the adverse effects of subclinical hypothyroidism (SCH) during pregnancy.

Aims and Objectives: This study was carried out to evaluate the prevalence of SCH in pregnancy and its adverse feto-maternal outcomes among mothers attending a tertiary care teaching hospital in Darjeeling district, West Bengal, India.

Materials and Methods: The present study was an institution-based observational descriptive study with a prospective longitudinal design conducted for 1 year among pregnant women attending the antenatal clinic of the study institution in the first trimester of their pregnancy. The sample size for the present study was calculated to be 200. A consecutive sampling technique was utilized. The enrolled women were evaluated for thyroid status by assessing serum thyroid stimulating hormone and free T4 level. All the enrolled mothers were kept under close follow-up and they were evaluated for the development of any antenatal, intranatal, and postnatal complications.

Results: The mean age was found to be 23.1±4.2 years, most of the women were nulliparous (60%). Of the women, 74% were euthyroid, while the prevalence of SCH was found to be 16%. On follow-up till the termination of their pregnancies, mothers suffering from SCH had statistically significantly higher incidence of maternal complications such as hypertensive disorders in pregnancy (P=0.001), abortion (P<0.001), postpartum hemorrhage (P=0.020) and also fetal adverse outcomes, such as intrauterine growth restriction (P=0.018), fetal premature birth (P=0.035), and low birth weight (P=0.004) when compared with euthyroid mothers.

Conclusion: The burden of SCH high in the study population, and it was significantly associated with a number of different maternal as well as fetal complications and adverse outcomes.

Effect of maternal pre-pregnancy body mass index and gestational weight gain on birth weight and gestational age: An observational cross-sectional study

Shaon Mitra, Arnab Mondal — Mon, 01 Apr 2024 00:00:00 +0000

Background: Studies show that pre-pregnancy body mass index (ppBMI) and gestational weight gain (GWG) are associated with birth weight (BW), gestational age (GA), and neonatal morbidities. Higher BW leads to metabolic syndrome. Preterm and low BW (LBW) have short and long-term morbidities. Monitoring ppBMI and GWG is necessary as these are modifiable risk factors for obesity. In this study, we revisited these findings in an Indian scenario.

Aims and Objectives: The primary objective is to study the association of BW and GA with ppBMI and GWG. The secondary objective is to study the association of ppBMI and GWG with cesarean section (CS), infant size, and early neonatal intensive care unit (NICU) requirement.

Materials and Methods: This observational cross-sectional study was conducted over 1 year with 230 mothers, after Institutional Ethics Committee approval and informed consent. Data were collected using predesigned pro forma and analyzed by SPSS. Digital weighing scales, stadiometer, and fenton growth charts were used.

Results: We found a positive linear correlation of ppBMI and GWG with BW. Obesity and excess GWG were associated with higher BW, large for GA, CS, and NICU stay. Overweight had more CS. Underweight and less GWG had a greater risk of LBW, preterm, and NICU stay. Less GWG had more small for GA.

Conclusion: GWG and ppBMI are determinants of BW, GA, and neonatal morbidities. Further studies should focus on exercise and nutrition in pregnant and reproductive age women so that healthy babies with low-risk of obesity, metabolic syndrome, and neurodevelopmental disabilities are born.

Obstetric outcomes of teenage pregnancies: A record-based study in a rural hospital of North 24 Parganas district, West Bengal

Paramita Sarkar, Payel Sarkar, Arnab Sarkar, Saibendu Kumar Lahiri — Tue, 02 Apr 2024 00:00:00 +0000

Background: Teenage pregnancy is a pregnancy in a woman within 10–19 years of age groups. It results from a number of factors such as early age at marriage, illiteracy, poverty, premarital sex, lack of awareness, and access to contraception. Teenage pregnancy imposes serious social and medical implications relating to both maternal and child health. It is a worldwide public health problem in both developed and developing countries.

Aims and Objectives: The study was conducted in a rural hospital of North 24 Parganas in West Bengal. The primary objective was to compare different maternal and perinatal outcomes of teenage primigravida mothers with those of adult primigravida mothers. The secondary objective was to assess the association between various sociodemographic factors on the prevalence of teenage pregnancy.

Materials and Methods: The cross-sectional hospital record-based study includes a sample of 78 study subjects each in cases and comparison group. Records were taken from June 2019 to December 2019.

Results: Of a total of 379 labor room admissions during the study period, 86 (22.69%) were of the teenage group and 8 cases were excluded from the study. A total of 78 teenage pregnancies were analyzed and compared with 78 adult pregnancies. The mean (standard deviation) age of teenage in our study was 18.10±0.63 and that of the comparison group was 22.74±1.68 years. Results revealed that teenage mothers had a statistically higher proportion of anemia (OR=2.30, P=0.05) and low-birth-weight babies (OR: 3.6, P=0.05) compared to adult-primigravida mothers, respectively.

Conclusion: Teenage pregnancy is still a rampant and important public health problem in India with unfavorable perinatal outcomes and needs to be tackled on a priority basis.

Awareness about basic life support among undergraduate medical students before and after clinical exposure in a tertiary care hospital attached to a medical school in South India

Mon, 01 Apr 2024 00:00:00 +0000

Background: Knowledge of basic life support (BLS) is one of the life-saving measures that every medical undergraduate student must possess.

Aims and Objectives: This study focused on knowing the level of knowledge in fresh medical undergraduate entrants (knowledge A [KA]) and 3rdyear students with clinical exposure but no BLS training (knowledge B [KB]). We also assessed the knowledge in 1st-year students (retention A [RA]) soon after foundation course and compared it with retained knowledge after 6 months (retention B [RB]).

Materials and Methods: This non-randomized multigroup cross-sectional study was done on medical undergraduate students in a tertiary care hospital attached to a medical school in South India. A validated questionnaire with 25 questions assessing knowledge of BLS was formulated and administered to 508 medical students.

Results: After analyzing data in SPSS V24, the mean scores in KA and KB were 11.03±4.33 and 13.95±5.43, respectively, with a P<0.001 which was significant. Although both the scores were >50%, clinical exposure had some effect on mean scores in medical undergraduates. Mean scores in RA and RB were 23.16±5.09 and 16.17±6.97, respectively, with P<0.001 which was significant, implying less retention of knowledge in RB 6 months after BLS training.

Conclusion: A foundation course introduced into the medical curriculum is essential and refresher courses should be conducted frequently to retain the knowledge of BLS as daily academic commitments can prevent retention of BLS knowledge.

Impact of antiretroviral therapy on cutaneous adverse drug reactions in adult HIV patients: A study from a tertiary care hospital

Mon, 01 Apr 2024 00:00:00 +0000

Background: Adverse drug reactions (ADRs) significantly impact public healthcare, especially among HIV patients. These reactions, which range from mild pruritus to severe conditions such as Steven-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), affect the quality of life and treatment outcomes.

Aims and Objectives: The current study was designed to evaluate the various types of cutaneous ADRs (CADRs) in adult HIV patients undergoing antiretroviral therapy (ART).

Materials and Methods: A retrospective record-based study was conducted at the Department of Dermatology, Venereology, and Leprosy, Government Medical College/Government General Hospital, Suryapet, Telangana, India. Data from November 2017 to October 2020 were analyzed, focusing on patients over 18 years on ART. Relevant demographic and medical data, including blood tests, liver and renal function, and CD4 counts, were collected.

Results: Out of 3532 patients on ART, 568 (16.08%) developed CADRs. Females represented 54.2% of these cases. The age group most affected was between 29 and 48 years. The most common ART regimen was Tenofovir+Lamivudin+Dolutegravir, followed by zidovudine-based combinations. Nevirapine-based regimens had a higher association with CADRs, particularly severe reactions such as SJS and TEN.

Conclusion: A significant proportion of HIV patients on ART experience CADRs, with certain drug combinations posing higher risks. This study highlights the need for careful monitoring and selection of ART regimens to minimize the risk of severe CADRs, thereby improving patient outcomes and quality of life in HIV treatment.

Prevalence of Candida species and their antifungal susceptibility patterns among patients in tertiary care setting Butwal, Nepal: A cross-sectional study

Tue, 02 Apr 2024 00:00:00 +0000

Background: Candida species, commonly present in the human body, can result in severe infections. Non-albicans Candida (NAC) species, with increasing antifungal resistance, pose a growing concern.

Aims and Objectives: This study aims to evaluate candidiasis prevalence and antifungal susceptibility in isolated Candida species among suspected patients at tertiary care hospitals in Butwal, emphasizing early identification and appropriate treatment to avoid unnecessary use of toxic antifungal drugs.

Materials and Methods: In a descriptive study on 303 patients with clinical symptoms of Candida infections, specimens underwent direct microscopic examination and culture on Sabouraud dextrose agar. Species identification involved phenotypic methods such as chromogenic character on CHROMagar Candida media, germ tube examination, and microscopic characteristics. Subsequently, isolated species were tested for antifungal susceptibility using the disc diffusion method.

Results: Among the 303 samples tested, 80 (26.4%) were positive for candidal infection. NAC species were the most commonly isolated, with Candida albicans and Candida krusei being the most virulent. The isolates exhibited the highest sensitivity to fluconazole (77.5%) followed by itraconazole (75%), whereas amphotericin B showed the lowest effectiveness with 63.75% resistance.

Conclusion: The rising prevalence of NAC species, particularly their growing resistance to Amphotericin B, has become a significant concern, as these species are frequently detected in various clinical samples. These findings underscore the importance of diligent monitoring and judicious selection of antifungal agents to ensure effective treatment strategies.

Comparative study of elective cholecystectomy with and without antimicrobial prophylaxis: A prospective randomized study

Pokhariya BMS — Mon, 01 Apr 2024 00:00:00 +0000

Background: Cholecystectomy is one of the most common, clean, and contaminated surgery operations performed by surgeons worldwide. Antibiotic prophylaxis in elective cholecystectomy is a controversial issue and our study was undertaken to evaluate the rate of infection and the usefulness and efficacy of antibiotic prophylaxis in elective cholecystectomies.

Aims and Objectives: The aims and objectives are to study antimicrobial prophylaxis on elective laparoscopic cholecystectomy and to compare surgical site infections (SSI) between the two groups after laparoscopic cholecystectomy with respect to (a) duration of surgery, (b) post-operative pain, (c) complications encountered, and (d) post-operative hospital stay.

Materials and Methods: Patients were randomly divided into the study group (Group A) and the control group (Group B). Antibiotic dose of ceftriaxone + sulbactam 1.5 g will be administered intravenously 2 h before induction of anesthesia for the patients in the study Group A (n=30), and no antibiotic will be administered prophylactically to the control Group B (n=30).

Results: In the study group, one patient developed fever, and in the control Group, 4 patients developed fever. In this study, SSIs were considered. In the study group, two patients (6.67%) developed pus discharge from the port site which was considered superficial infection, and in the control group, five patients (16.67%) developed pus discharge.

Conclusion: Based on our study, in elective cholecystectomy, a single dose of intravenous ceftriaxone + salbactam 1.5 g given before the operative procedure does not lead to a higher SSI rate as compared to the conventionally given antibiotics which are continued postoperatively for a variable length of time.

Study of aerobic bacteriology profile of chronic suppurative otitis media

Ujwala A Lokhande, Suresh L Akulwar, Annasaheb Lokhande — Mon, 01 Apr 2024 00:00:00 +0000

Background: Chronic suppurative otitis media (CSOM) poses a recurring and persistent challenge in otolaryngology, stemming from diverse etiologies. Understanding the regional prevalence of the predominant etiological agent and its antimicrobial susceptibility is crucial for effective management.

Aims and Objectives: This study aims to determine the aerobic bacterial profile and prevalent bacterial etiology responsible for CSOM in our geographical setting.

Materials and Methods: Conducted over 2 years in the microbiology department of a tertiary care hospital, this study enrolled 504 clinically diagnosed otitis media cases. Participants, presenting with discharging ears at the E.N.T. department, met inclusion criteria of chronic otitis media with or without complications. Patients had not received treatment for at least 7 days before sample collection.

Results: Among the 402 CSOM samples, aerobes were isolated from 70.15%, anaerobes from 73.63%, and mixed isolates (aerobes+anaerobes) from 38.06%. Solely aerobes were present in 32.08% of samples, while solely anaerobes were found in 35.57%. Monomicrobials constituted 75.88%, and polymicrobials accounted for 24.11% of the samples.

Conclusion: In conclusion, this study enhances our understanding of CSOM microbiology in our region, providing insights into organism prevalence, mixed infections, and antibiotic sensitivity. The findings offer clinicians valuable data for tailored treatment strategies, emphasizing the need for individualized scrutiny to address the dynamic nature of CSOM bacteriology over time.

Study the carotid Doppler and computed tomography of head in ischemic stroke patients

Tilchan Pandey, Jeevan Khanal, Shami Pokhrel, Himal Ghimire, Bikash Poudel — Mon, 01 Apr 2024 00:00:00 +0000

Background: A stroke is an episode of acute neurological dysfunction from either ischemic infarction or a collection of blood within the brain or ventricular system with resultant focal injury of the central nervous system. The estimated global incidence of stroke is 2–3/1000 person-years, with older patients and patients with carotid artery stenosis or atrial fibrillation having the highest risk. Hence, carotid studies may help with early prevention and management in patients.

Aims and Objectives: We aimed to study the prevalence of carotid artery stenosis in acute ischemic stroke and the association of risk factors.

Materials and Methods: This was a descriptive study conducted in the department of internal medicine over a period of 6 months. It was carried out in 125 ischemic stroke patients’ inpatient departments. The ischemic stroke was established with history, examination, and computed tomography (CT) with carotid color Doppler study for percentage of stenosis.

Results: The 47 (37.6%) stroke patients had carotid stenosis <50% and 78 (62.4%) had >50%; out of them, 32% (40) had (≥50–69%) stenosis, 24% (30) exhibited 70–99%, and 6.4% (8) reported total occlusion. In the CT brain, lacunar infarcts were found in 42 (33.6%), normal and middle cerebral artery infarcts in 27 (21.6%), anterior cerebral artery infarcts in 17 (13.6%), and posterior cerebral artery infarcts in 12 (9.6%). In clinical profiles, 75 (60%) patients presented with right-sided hemiparesis, 50 (40%) with left-sided hemiparesis, 62 (49.6%) with loss of consciousness, 28 (22.4%) with dizziness, and 31 (24.8%) with motor aphasia. Conventional risk factors include hypertension in 68 (54.4%), diabetes in 39 (31.2%), dyslipidemia in 58 (46.4%), heart disease in 65 (52%), and smoking in 51 (40.8%). In the present study, the majority of patients found carotid stenosis >50%, lacunar infarcts were the most common CT findings, and right hemiparesis was common paresis. Hypertension was the most common risk factor among others, and all were significant (P<0.05) for the stroke.

Conclusion: There is a high prevalence of carotid stenosis, with >50% in ischemic stroke patients with hypertension being the most common risk factor.

A prospective study on the incidence and outcome of cranial nerve injuries in patients with traumatic brain injuries

Nikhil Khantal, Kankane Kumar Vivek, Avinash Sharma — Mon, 01 Apr 2024 00:00:00 +0000

Background: The worldwide mortality and morbidity rates are highest for traumatic brain injury (TBI), which frequently involves damage to the cranial nerves (CNs). The occurrence of CN injury (CNI) in craniocerebral trauma ranges from 5 to 23%.

Aims and Objectives: The objective of this study is to evaluate the occurrence of CNI in TBI patients within our population and determine the association between CN involvement and the severity of head injuries. In addition, we aim to assess the outcomes of patients who experience CNI in cases of head trauma.

Materials and Methods: In our institution, a prospective observational analytical study was conducted from July 2022 to June 2023. The study included 100 patients aged over 1 year who had sustained head injuries. These patients were followed up for a period of 6 months.

Results: Our study included a total of 100 patients, revealing that the highest number of head injuries occurred within the age range of 20–60 years, with an average age of 46 years. Among the study population, males accounted for 74%. Of these patients, 66 had mild head injuries, 22 had moderate head injuries, and 12 were admitted with severe head injuries. We discovered that 15% of TBI patients experienced CNIs. Specifically, five patients had a single CN palsy, while three patients had multiple CN palsies. Road traffic accidents accounted for 78% of the cases, making them the most common cause of injury, while low-velocity injuries only made up 22% of the cases. The facial nerve was the CN most frequently affected, followed by the olfactory nerve, optic nerve, and vestibulocochlear nerve. Among the 15 patients with CNI, seven had delayed symptoms, whereas eight patients presented with immediate symptoms.

Conclusion: A substantial proportion of patients experience a delayed onset of CNI symptoms. Therefore, it is essential to perform a comprehensive neurological examination of all CNs during follow-up for all TBI patients.

Clinico-radiological study in head injury due to road traffic accident caused by stray animals

Mon, 01 Apr 2024 00:00:00 +0000

Background: In India, the alarming rise in Road Traffic Accidents (RTAs) is a pressing concern that poses significant threats to public safety and infrastructure.

Aims and Objectives: The study was conducted to know the clinico-radiological aspect and associated mortality and morbidity of cases of RTAs caused due to stray animals in central India.

Materials and Methods: This current study was a prospective observational study done in the premier institute of central India from April 2023 to July 2023. All RTA patients due to impact with stray animals attending the trauma and neurosurgery department of our institute for 3 months (April 23, 2023–July 30, 2023) were included in the study.

Results: A total of 50 patients were recruited for the study. The median age of the patients was 29.00 years (20.00–41.00) (Range). The gender distribution M: F was 38:12. Five (10%) patients reached the T and E within the golden hour (first 1 h). Evening time (42%) was the most common time of accidents (12 PM–6 PM), followed by (6 PM–AM). Analysis of vehicles involved in RTA revealed two-wheelers in 95%, three-wheelers in 3%, and other vehicles in 2% cases. About 34% of total victims were drivers, and 66% were pillion riders or occupants of the vehicle.

Conclusion: Our prospective, cross-sectional study aimed to highlight the facts of the increased incidence of RTAs due to stray animals roaming freely on roads, thus adding significant morbidity and costs to society.

An observation into the conduction of nerve fibers and goniometry in women with hypothyroidism

Syed Madhar Shah K, Kavitha P, Shalini S, Janardhanan S — Mon, 01 Apr 2024 00:00:00 +0000

Background: The thyroid hormone is so essential that it is involved in the functioning of all the body systems, especially in the development of the brain in fetal life. The World Health Organization has estimated that around 2 billion individuals are suffering from thyroid disorders. Hence, it is essential to identify and diagnose hypothyroid patients so that the treatment strategy can be started at the earliest.

Aims and Objectives: The present study aimed to find out the peripheral nerve conduction velocity, range, and degree of movement of joints in newly diagnosed hypothyroid women and compare them with those of normal euthyroid women.

Materials and Methods: The present study was a case–control study conducted from July 2015 to March 2016. A total of 50 cases of newly diagnosed hypothyroid women and 50 age-matched euthyroid women were part of the study after obtaining written and informed consent. Thyroid estimation was performed in the Clinical Biochemistry Department by the ELISA method, and nerve conduction studies were performed in the Neurology Department.

Results: The age and height of the participants were not statistically significant. Weight and body mass index were significantly higher in the cases when compared to the control group. Sensory and motor conduction velocities of the right median nerve are significantly less in these cases when compared to control group participants. Sensory and motor conduction velocities of the right ulnar nerve are significantly less in these cases when compared to control group participants. Sensory and motor conduction velocities of the left median nerve are significantly less in these cases when compared to control group participants. Sensory and motor conduction velocities of the left ulnar nerve are significantly less in these cases when compared to control group participants. The goniometric parameters (right and left sides) of the cases and control group participants were not significantly different.

Conclusion: Hypothyroid women have a delay in peripheral nerve conduction velocities, including sensory and motor components, and the degree and range of movements of limb joints were not affected. A nerve conduction study may be utilized as a routine screening test for hypothyroid individuals so that hormone replacement therapy can be instituted at the earliest.

Early experience with the use of Cissus quadrangularis and Dalbergia sissoo therapy on bone marrow edema and knee pain associated with degenerative medial compartment knee osteoarthritis

Mon, 01 Apr 2024 00:00:00 +0000

Background: Bone marrow edema (BME) refers to the accumulation of excess fluid in the bone marrow, often indicative of injury or inflammation. Some studies suggest that incorporating plant-based therapies, rich in anti-inflammatory compounds and nutrients, may contribute to alleviating BME and promoting overall bone health.

Aims and Objective: The study aims to evaluate the effect of Cissus quadrangularis and Dalbergia sissoo therapy on BME and knee pain associated with degenerative medial compartment knee osteoarthritis (OA).

Materials and Methods: This retrospective study examined seven individuals with medial tibial condyle BME associated with medial compartment OA. These patients were treated with initial 10 days of non-steroidal anti-inflammatory drugs along with once-a-day tablet containing C. quadrangularis (500 mg) and D. sissoo (400 mg). Visual analogue scores (VAS) and Oxford knee score (OKS) were noted at the beginning of the therapy and at 12 weeks of completion of therapy. Before treatment, BME (percentage of the medial tibial condyle) and presence/absence of subtle subchondral fracture were diagnosed with T2-weighted magnetic resonance imaging (MRI) images, and subsequently, its resolution was confirmed with a repeat MRI scan at 12 weeks.

Results: At the end of 12 weeks of therapy, there was a statistically significant improvement in the mean VAS score (baseline 8.14±0.90 improved to 2.00±0.58 at 12 weeks, [P<0.0001]), OKS (baseline 25.71±1.80 improved to 36.57±1.51 at 12 weeks, [P=0.0001]), and there was statistically significant decrease in mean BME (baseline 37.86±10.35% decreased to 14.29±4.50% at the end of 12 weeks, [P=0.0001]).

Conclusion: Our early experience shows that the combination therapy of C. quadrangularis + D. sissoo is effective in relief of pain, improvement in knee function, and resolution of BME associated with medial compartment knee OA. This combination is safe, effective, and well-tolerated by patients’ population.

Study of association of thrombocytopenia and serological parameters in dengue fever with special reference to NS1 antigen in hilly Region of Northern India

Nidhi Negi, Yogita Rawat, Shekhar Pal, Ruhi Hasan, Arti Negi — Mon, 01 Apr 2024 00:00:00 +0000

Background: Dengue fever is an arthropod-borne disease transmitted to humans by Aedes aegypti mosquitoes and one of the leading causes of arthropod-borne viral disease in the world.

Aims and Objectives: The present study aims to analyze any association between platelet count and immunochromatography -based dengue serology tests.

Materials and Methods: This was a cross-sectional study conducted in Government Doon Medical College and Hospital. A total of 19,208 clinically suspected cases of dengue who reported in various outpatient departments, emergency services, and inpatient departments of our hospital between June 2023 and November 2023 were included in this study. Samples were tested by rapid immunochromatographic test for dengue non-structural protein 1 (NS1) antigen, immunoglobulin M (IgM), IgG, and platelet count was also obtained and a comparison was made.

Results: Out of total 19,208 samples tested, 4876 (25.38%) samples were positive for NS1, 589 (3.06%) samples were positive for IgM. Majority of the patients were in the age group of 21–40 years 9274 (48.28%). 11,753 (61.19%) were males and 7455 (38.80%) were females. A strong correlation was seen between NS1 and thrombocytopenia where a total of 2737/4876 (n=56.13%) patients showed positivity in NS1 with low platelet counts.

Conclusion: Detection of NS1 antigen helps in early diagnosis of dengue to avoid complications significantly. In confirmed dengue cases with fever, thrombocytopenia is more consistently found and can be used as a predictor to reduce the morbidity and mortality of dengue disease.

Importance of bone marrow examination in cases of pancytopenia: A morphological study in a tertiary care center

Deepshikha Verma, Ranjan Yadav, Rajnikant Ahirwar, Pratibha Meena — Mon, 01 Apr 2024 00:00:00 +0000

Background: Anemia, leukopenia, and thrombocytopenia are all combined as pancytopenia. It could be a symptom of many diseases that directly or indirectly impact the bone marrow. The cause of pancytopenia, however, differs depending on the location. An essential step in determining the cause of pancytopenia is bone marrow aspiration (BMA).

Aims and Objectives: This study aimed to determine the causes of pancytopenia and the morphology of the bone marrow in pancytopenia patients.

Materials and Methods: This study was carried out over a year in the pathology department of a tertiary care facility in central India. Patients taking chemotherapy or radiation therapy were excluded from the study. Inclusion Criteria: Cases with hemoglobin <10 g/dL, total leukocyte count <4000/mm3, and platelet count <100,000/mm3 were included in this study. The patient’s posterior iliac crest was used for BMA. The Leishman stain was used to color BMA smears for microscopy.

Results: This study comprised 51 cases of pancytopenia, with acute leukemia and megaloblastic anemia accounting for the majority (11 cases each out of 51), followed by dimorphic anemia (10/51), hypocellular marrow (9/51). The clinical symptom of generalized weakness and pallor was present in all instances (100%) and was followed by fatiguability (72%) and dyspnea (48%). The last two least frequent symptoms, lymphadenopathy, and hepatomegaly, were also present in many patients. A significant proportion of pancytopenia individuals experienced lymphadenopathy and hepatomegaly, which were the last two least prevalent appearances.

Conclusion: In most cases, bone marrow aspiration in pancytopenia patients aids in determining the underlying reason. Understanding the illness process, planning future research, and managing cytopenia patients can all benefit from it.

Concordance between conventional cytology and cell block of suspected malignant pleural effusion: A record-based study in a tertiary care center of eastern India

Mon, 01 Apr 2024 00:00:00 +0000

Background: Cytological study of pleural fluid helps establishing the underlying cause of pleural effusion. It is considered the most important tool in diagnosing malignancy in effusions. However, accurate identification of cellular morphology can be a problem in conventional cytology. Cell block preparation from pleural effusion aids in this diagnosis due to the preservation of tissue architecture, and multiple sections can be obtained for further studies.

Aims and Objectives: The objectives of this study were to compare the diagnostic results of conventional cytology and cell block studies of suspected malignant pleural effusions and find out the diagnostic agreement or concordance between the two methods.

Materials and Methods: A record-based study was conducted at the Department of Pathology on conventional cytology and cell block study reports of 150 suspected malignant pleural effusion cases over 35 months. The diagnoses were expressed in five categories – non-diagnostic, negative for malignancy, atypia of undetermined significance, suspicious for malignancy, and malignant. χ2 test was used to identify the percentage of malignancy reported. Agreement of both methods was assessed through Kappa statistics.

Results: About 4.67% of cases were reported as malignant by conventional cytology, whereas cell block study diagnosed malignancy in 19.33% of cases. Relative diagnostic agreement between the two methods was 0.73 and concordance by Cohen’s Kappa was 0.34, which signifies fair concordance.

Conclusion: Cell block study, though having a fair concordance, is much superior to conventional cytology smears in detecting malignant cells and diagnosing a pleural effusion as malignant.

Histopathological spectrum of lesions of upper gastrointestinal tract – A study of endoscopic biopsies

Mon, 01 Apr 2024 00:00:00 +0000

Background: Gastrointestinal (GI) disorders are one of the most commonly encountered health problems in routine clinical practice. Dietary, environmental, geographic, and genetic factors are some of the key reasons contributing to the prevalence of these diseases. A wide spectrum of lesions is observed on histopathological examination of the upper GI tract (GIT).

Aims and Objective: The study was carried out to determine the histopathological spectrum of upper GIT lesions and to compare the lesions with demographic and clinical data.

Materials and Methods: The study was conducted on all consecutive upper GI endoscopic biopsies received in the Department of Pathology, Narendra Modi Medical College, Ahmedabad during the period from August 2020 to October 2022.

Results: Non-neoplastic lesions were observed in 91.3% of all upper GI biopsies. Among these, gastric lesions (63.3%) were the most common followed by duodenal lesions (21.3%) and esophageal lesions (6.6%). The most commonly observed non-neoplastic lesions from the esophagus, stomach, and duodenum were reflux esophagitis with its consequence Barrett’s esophagus, chronic gastritis, and chronic duodenitis, respectively. Neoplastic lesions were observed in 8.7% of all upper GI biopsies; out of which 4% were esophageal, 3.3% were gastric and 1.3% were duodenal. The most commonly observed neoplastic lesions from the esophagus, stomach, and duodenum were squamous cell carcinoma of the esophagus, adenocarcinoma of the stomach, and adenocarcinoma of duodenum, respectively.

Conclusion: Endoscopic biopsy examination followed by histopathologic assessment is a convenient procedure and current gold standard for the accurate diagnosis of patients with upper GIT lesions.

A prospective study on change of QTc interval with antipsychotic medications in patients of schizophrenia and related psychotic disorder

Shaswata Mandal, Nitu Mallik, Rudraprasad Acharya, Manoj Kumar — Mon, 01 Apr 2024 00:00:00 +0000

Background: Sudden unexplained death in individuals with mental health problems was described in 1960 and a link with antipsychotic drugs was postulated over 40 years ago. Down the years, a clear relation between electrocardiography (ECG) abnormalities and antipsychotic use was observed with special emphasis on QT prolongation. Various factors modulate the risk of QT prolongation including gender, age, race, and drug choice. An evaluation of antipsychotic use-induced QT changes in Eastern Indian population is the dire need of the hour.

Aims and Objectives: The aim and objective are to study the effects of risperidone, olanzapine, and aripiprazole on QT interval after a period of 4 weeks of usage in previously drug-naïve Eastern Indian psychotic patients.

Materials and Methods: A total of 78 drug-naïve patients fulfilling inclusion and exclusion criteria were randomly assigned to receive risperidone, olanzapine, and aripiprazole after a baseline ECG. A repeat ECG after 4 weeks of drug usage was done and compared using standard protocols with respect to QT interval. Findings were tabulated and statistical analysis was done using SPSS 25.0 to test for statistical significance at P<0.05.

Results: Our study found significant rise in QT values after 4 weeks of using olanzapine and aripiprazole, but not with risperidone. However, none of the patients from either of the groups experienced any incidence of QT prolongation. Rise with olanzapine was significantly higher than that with risperidone.

Conclusion: Caution is suggested in patients with risk factors for QT prolongation or a high value of QT during prescribing olanzapine. Studies with larger sample size can be carried out to find genetic predisposition of Indian population to anti-psychotic induced QT interval rise/prolongation.

An overview of the clinical profile of infertile patients who underwent hysterosalpingography

Imran Nazir Salroo, Zahoor Ahmad Raina, Mohd Farooq Mir, Muzamil Rasool — Mon, 01 Apr 2024 00:00:00 +0000

Background: Infertility is a prevalent medical issue that can arise from challenges in male or female or both partners. Pivotal contributing factors to female infertility include dysfunction, tubal issues, and peritoneal factors. Hysterosalpingography (HSG) holds significant importance in assessing abnormalities associated with the uterus and fallopian tubes.

Aims and Objectives: This study aimed to assess the clinical profile and hysterosalpingographic findings of women with infertility who visited the department of radiodiagnosis for HSG.

Materials and Methods: This is a cross-sectional study, where consecutive convenience-based sampling was used, with ethical clearance in place. Sixty-three infertile women of reproductive age were recruited for the study and were referred for HSG by the Department of Obstetrics and Gynecology.

Results: The majority of the participants had primary infertility (71.88%) and was in the 31–35-year age group with the majority having 3–6 years of infertility and endometriosis. On HSG uterine pathology was found in 9.37% of participants and unilateral and bilateral tubal blocks were seen in 18.75% and 14.06% of cases approximately.

Conclusion: HSG is a minimally invasive procedure, secure, and plays a crucial role in diagnosing uterine and tubal factors contributing to infertility.

Clinical and radiological correlation of pulmonary manifestations in rheumatoid arthritis

Srilakshmi M Prabhu, Ram Shenoy Basti — Mon, 01 Apr 2024 00:00:00 +0000

Background: Rheumatoid arthritis (RA) is a chronic inflammatory arthritis with various extra-articular manifestations, pulmonary being the most involved.

Aims and Objectives: This study aims to identify the radiological patterns in the lungs among patients with RA.

Materials and Methods: A total of 39 patients with RA were chosen randomly. They were examined and imaged by chest X-ray and high-resolution computed tomography (HRCT) thorax, and findings were analyzed.

Results: The mean age of patients was 53.9 and had a female preponderance of 74.4%. Among the 39 patients studied, 30 had no respiratory symptoms. The most common HRCT thorax findings were bronchiectasis and ground-glass opacities.

Conclusion: Radiological pulmonary manifestations of RA identified in HRCT imaging are wide and occur in the majority of clinically asymptomatic patients.

Evaluation of hepatic and renal functional changes in patients undergoing laparoscopic cholecystectomy

Snehasish Nath, Suniti Kumar Hajra, Debayan Chowdhury — Mon, 01 Apr 2024 00:00:00 +0000

Background: In this era of laparoscopic surgery, with the use of carbon dioxide insufflation in creating pneumoperitoneum for ease of trocar insertion and visualization of anatomy, it comes certain systemic changes in the patient due to the compression effect of the gas as well as resorption of it through peritoneum.

Aims and Objectives: The aim of the study was to assess baseline standards of hepatic and renal functional status in pre-operative patients in comparison with post-operative patients undergoing laparoscopic cholecystectomy (LC).

Materials and Methods: Cases were chosen among the persons who presented with chronic calculus cholecystitis to the surgical out-patient department of Ramakrishna Mission Seva Pratishthan, Vivekananda Institute of Medical Sciences, Kolkata. Pre-operative liver function tests (LFT) and renal function tests (RFT) values were recorded. Again, LFT and RFT values were evaluated on post-operative day 1 (POD1) and POD12.

Results: Serum conjugated and unconjugated bilirubin, aspartate amino transaminase, alanine amino transaminase, urea, estimated glomerular filtration rate values increases immediate postoperatively on POD1 but returns to normal pre-operative levels on POD 12. Serum alkaline phosphatase, albumin, and creatinine values decrease on POD1 and return to normal pre-operative values in POD 12.

Conclusion: Hepatic and renal function changes in the immediate post-operative period of 24 h following LC. This change is transient and returns to normal levels within POD 12.

Study of incidence of occult pneumomediastinum due to blunt chest trauma

Mon, 01 Apr 2024 00:00:00 +0000

Background: Pneumomediastinum refers to the presence of extraluminal gas within the mediastinum. If signs of pneumomediastinum are not present on chest X-ray and it is detected on contrast-enhanced computed tomography (CECT) thorax then it is known as occult pneumomediastinum. There is a dearth of literature regarding occult pneumomediastinum in patients with blunt chest trauma.

Aims and Objectives: This study was done to see the incidence as well as outcome of occult pneumomediastinum in patients of blunt chest trauma.

Materials and Methods: A prospective study was done in the department of general surgery at a tertiary care institute in which a total of 32 patients with blunt chest trauma were taken. The patients with occult pneumomediastinum were identified using CECT and appropriate management was done in all patients. Correlation of occult pneumomediastinum with subcutaneous emphysema, rib fracture, jugular venous pressure (JVP), pleural effusion, and outcome was seen.

Results: It was evident from this study that 18.8% of patients of with chest trauma had occult pneumomediastinum. Incidence of blunt chest trauma is most common in the age group of 31–60 years as this age group is more vulnerable to roadside accidents and other accidents. There is a strong correlation between the presence of central subcutaneous emphysema, raised JVP, and worse outcomes with occult pneumomediastinum (P<0.05).

Conclusion: This study showed a high incidence of occult pneumomediastinum in patients with chest trauma which is ultimately associated with high mortality. Hence, we should keep high index of suspicion regarding the presence of occult pneumomediastinum so that timely management of these patients can be done to prevent morbidity and mortality.

Herringbone stitch technique versus interrupted suturing technique for rectus closure in emergency laparotomy: A comparative study

Mon, 01 Apr 2024 00:00:00 +0000

Background: Midline laparotomy incisions provide easy and rapid access to the peritoneal cavity in case of emergency surgery and effective closure of the abdominal wall is crucial for optimal healing and reduced complications. Secure abdominal wall closure after any laparotomy is every surgeon’s aim.

Aims and Objectives: The aim of the study was to choose the better method of rectus closure by comparing the herringbone stitch technique with the interrupted suturing technique for rectus closure in emergency laparotomy.

Materials and Methods: Fifty patients who underwent midline emergency laparotomy at MGM Medical College and MY Hospital, Indore, between January 2023 and April 2023 were included in our study. In 25 patients (Group A) herringbone stitch technique was used whereas in the other 25 patients (Group B) interrupted suturing technique for rectus closure was used and they were assessed based on the incidence of surgical site infection (SSI), superficial wound dehiscence, fascial dehiscence, and incidence of incisional hernia.

Results: The incidence of SSI was comparable in both groups but the incidence of superficial wound dehiscence, fascial dehiscence, and incisional hernia is less in Group A.

Conclusion: The herringbone stitch technique is better as compared to the interrupted suturing technique for rectus closure in emergency laparotomy.

A prospective study of post-operative complications and its management following open hemorrhoidectomy in a tertiary care hospital

Amalesh Barman, Niharika Lama, Sisir Das, Dibyajit Datta — Mon, 01 Apr 2024 00:00:00 +0000

Background: Surgery is the most effective treatment for hemorrhoids and is particularly recommended for prolapsing piles during defecation that may be reduced manually (Grade III) and irreducible hemorrhoids (Grade IV). Numerous methods have been proposed for surgical therapy, and most have similar success rates. But serious post-operative complications are rarer in open technique than stapled hemorrhoidopexy. Prompt identification of post-operative complications is necessary to avoid significant patient morbidity.

Aims and Objectives: The present study was done to access post-operative complications and their management, like post-operative pain, urinary retention, wound infection, bleeding, anal incontinence, and anal stenosis following open hemorrhoidectomy during the post-operative and follow-up periods.

Materials and Methods: This was an observational prospective study carried out at the Department of Surgery of Midnapore Medical College and Hospital from April 1, 2021, to September 30, 2022, with 100 patients.

Results: Out of 100 open hemorrhoidectomy cases, 74% belonged to the 31–50 year age group, 16% belonged to the 18–30 year age group, and only 10% were aged >50 years, respectively. The mean age of our study population was 40.62. Males were predominantly higher than females (79% vs. 21%). There was 7% of patients had bleeding per rectum, 22% had urinary retention, and 4% had wound infection after open hemorrhoidectomy. Mean and standard deviation value of post-operative pain score was found in post-operative day (POD-1) 6.15±0.85, POD-3- 4.25±0.99, POD-7- 2.43±1.40, after 28 days mean value pain score was 0.66±1.19, after 84 days mean pain score was 0.05±0.21. After 6 months of follow-up, there was no significant complication found.

Conclusion: We found that the important advantages of Milligan Morgan open hemorrhoidectomy achieve in terms of pain and wound healing, hospital stay. It was less expensive and safe, easy to perform with satisfactory results and in long run it did not have significant post-operative complication.

Complications and retrieval of forgotten biliary stents: A clinical insight

Mon, 01 Apr 2024 00:00:00 +0000

Background: Endoscopic biliary stenting is a common procedure in gastroenterology that uses plastic stents for short-term bile drainage.

Aims and Objectives: This study explores the occurrence and consequences of forgotten or retained biliary stents.

Materials and Methods: Conducted at King George Hospital in Visakhapatnam over 8 months, the study includes 12 patients with forgotten biliary stents. Diagnostic confirmation used X-rays, abdominal ultrasound, and magnetic resonance cholangiopancreatography. Four patients faced complications such as fractured distal pigtails and blocked stents, making retrieval challenging through standard methods like endoscopic retrograde cholangiopancreatography (ERCP) and cholangioscopy.

Results: The study involved 12 patients (median age: 48 years), with choledocholithiasis being the main reason for stent placement in 10 cases (83.3%). On average, patients showed symptoms 31.3 months after stenting, mostly presenting with cholangitis (83.3%). Stent removal was successful in 8 cases (66.6%) using ERCP, while advanced procedures like cholangioscopy or surgery were needed in the rest. No mortality was reported.

Conclusion: Conducted during the COVID-19 pandemic, this study reveals a rise in neglected plastic biliary stents. Cholangitis, often with common bile duct stones, was a common complication. Standard ERCP techniques were less effective in cases with complicated stents, requiring alternative approaches like cholangioscopy or surgery. The cases emphasize the urgency of timely stent retrieval and the need to improve management protocols to prevent complications.

Small cell variant of osteosarcoma of the patella: A rare case report with review of literature

Javed Ahmad, Brij Mohan Patel — Mon, 01 Apr 2024 00:00:00 +0000

Patella is an uncommon site for the occurrence of bone tumor. Benign tumors are more common as compared to malignant ones. Osteosarcoma of the patella is a very rare tumor with only a few cases reported in the literature. Here, we present a rare case of a small-cell variant of osteosarcoma of the patella. A 12-year-old boy presented to us with pain and swelling over his left knee for 6 months. On X-ray, expansion with osteosclerotic and osteolytic lesions was found in the patella and a suspected diagnosis of osteosarcoma was made. The patient was managed by excisional biopsy of the patella and V–Y plasty of the quadriceps tendon. Results of histopathological and immunohistochemistry analyses were consistent with osteosarcoma of small cell variant. The patient was referred to a higher center after the operation for radiotherapy and chemotherapy. On the final follow-up, after 1 year, the patient was found to have expired. Osteosarcoma of the patella is a rare condition. Further studies with a number of cases and longer duration of follow-up are warranted to obtain better insight that can aid in devising management protocol, prediction of survival, and functional outcome of different surgical interventions for these patients.

Exploring delusional parasitosis – a case series of three patients

Abhishek Pathak, Manish Singh, Yogi Rana, Vishesh Yadav, Rahul Singh — Mon, 01 Apr 2024 00:00:00 +0000

Delusional parasitosis is a psychiatric condition where individuals believe they are infested with parasites despite lacking medical evidence. This often leads to underestimation within psychiatric settings. Three patients with delusional parasitosis, aged above and below 50, presented with symptoms lasting from 1 to 6 months. Two had consulted specialists before, and one had primary delusional parasitosis while two had secondary due to schizophrenia and depression. Tablet Olanzapine showed partial response in one patient before admission. Tablet Risperidone resulted in complete symptom resolution within 10 days in two patients and within 1 month in one patient. Randomized controlled trials on antipsychotics for delusional parasitosis treatment are lacking. Further research is needed to assess treatment recommendations. Psychiatrists should report cases to provide clinical evidence supporting treatment decisions.

Isolated Gastric Perforation following Blunt Trauma Abdomen not to be Missed: A Case Series

Mon, 01 Apr 2024 00:00:00 +0000

Abdominal trauma is a commonly encountered emergency which may be because of roadside accidents, assaults, or falls from height. Blunt injury to the abdomen is far more common than penetrating injury. Gastric perforation commonly occurs following penetrating abdominal trauma. However, gastric rupture is an uncommon entity following blunt trauma abdomen (BTA). Here, we are presenting three cases of isolated gastric perforation after BTA, two were due to a roadside accident, and one was a result of a fall from height. History suggests of a full stomach is usually found in traumatic gastric rupture. This condition usually presents with insignificant clinical or radiological signs. Isolated gastric rupture due to trauma is rare as it is usually associated with other injuries such as splenic and liver injuries. Early suspicion plays an important role in diagnosing this entity which carries higher morbidity and mortality if not managed timely. As isolated gastric perforation because of trauma leads to high morbidity and mortality, hence thorough lavage of the peritoneal cavity followed by double-layer closure after adequate debridement will reduce chances of intraperitoneal contamination thus improving outcome. Presentation after the last meal, the severity of gastric rupture, and other associated injuries play an important role in the prognosis of the patient.

Primary stromal sarcomas of the breast: Case series on a rare entity

Soumita Ghosh Sengupta, Bidisha Chakraborty, Kaushik Saha, Gargi Raychaudhuri — Mon, 01 Apr 2024 00:00:00 +0000

Primary breast stromal sarcomas are rare entities arising from connective tissue within the breast, accounting for <5% of all soft tissue sarcomas and <1% of malignant breast tumors. Primary breast sarcomas are locally aggressive tumors and should be differentiated from malignant phyllodes tumor and metaplastic carcinoma of the breast, which are close mimickers. Here we present 4 cases of primary breast sarcoma that we found over the course of 7 years in our institution who presented with a breast lump. Mastectomy was performed, and they were diagnosed as primary stromal sarcoma of the breast.

A case series of adult abdominoscrotal hydrocele: A rare condition

Arpit Agrawal, Mansi Agrawal, Saranshi Shrivastava, Sagar Arora — Mon, 01 Apr 2024 00:00:00 +0000

Abdominoscrotal hydrocele (ASH) is a relatively rare variant of hydrocele in both adult and pediatric populations. The incidence among adults is <1% of other types of hydroceles, which are different from most cases related to persistent processus vaginalis. It presents as a dumbbell-shaped cystic collection with cross-fluctuation in the abdominoscrotal region and the inguinal canal acting as the rod connecting two masses. The abdominal swelling could be retroperitoneal or intraperitoneal. Clinical examination can lead to a suspected diagnosis of ASH, but confirmation relies on ultrasonography and computed tomography. Spontaneous resolution of ASH has been unlikely, and hence surgical intervention is recommended. In this study, we present three cases with ASH who underwent surgical repair using different methods.