bluuebunny/crossref_metadata_2025 huggingface dataset:
A Prospective Comparative Study in Laparoscopic Inguinal Hernia Repair with Regard to Fixation and Non-Fixation of Mesh in a Tertiary Care Centre in Northern India
Authors: Kala Sanjay , Jauhari Ramendra Kumar , Singh Anurag , Kulkarni Abhishek V.
Published: September 2021

BACKGROUND The debate between fixation and non-fixation of mesh in laparoscopic hernia surgery has been going since the advent of this technique. While earlier studies insisted on mesh fixation, emerging studies are now supporting elimination of mesh fixation. Therefore, a prospective comparative study was performed in tertiary health care centre in northern India to compare the incidence of recurrence, post-operative pain and chronic groin pain between mesh fixation and non-fixation. In this study, we wanted to compare the intra-operative complications, post-operative pain and recovery, duration of hospital stay, incidence of chronic groin pain and pain during follow up visits and incidence of recurrence in laparoscopic inguinal hernia repair between fixation and non-fixation of mesh. METHODS A prospective comparative study was conducted among 50 patients admitted in surgery unit in a tertiary health care centre in northern India from January 2019 to October 2020 and were divided into two groups (group A - fixation, group B - non-fixation). Different factors such as post-operative pain, analgesia required post-operatively, duration of hospital stay, chronic groin pain and recurrence were compared between the two groups. Patients were followed up at 1, 3, 6 and 12 months. RESULTS The mean pain score at the end of 1 month and 3 months was higher in patients in the mesh fixation group. The days required by patients to resume their routine activities was lesser in patients in the non-fixation group. The recurrence rate was found to be similar in both the groups. CONCLUSIONS Mesh fixation offers no clear advantage over non-fixation and non-fixation can be considered as the preferred alternative as this procedure has less chance of postoperative pain, early ambulation and no increased risk of recurrence. KEYWORDS Laparoscopic Inguinal Hernia Repair, Mesh Fixation, Mesh Non-Fixation
Betamethasone Gel and Lignocaine Jelly Applied Over Endotracheal Tube to Reduce Post-Operative Sore Throat and Hoarseness of Voice - A Comparative Study
Authors: Boddu Sridevi , Kakaraparthi Chenna Kesava Swamy
Published: September 2021

BACKGROUND Although post-operative sore throat, cough and hoarseness of voice (HOV) are minor sequelae after general anaesthesia (GA), these can be troublesome to the patient. This study was done to compare the efficacy of betamethasone gel and lignocaine jelly as lubricants in reducing post-operative sore throat and hoarseness of voice in patients operated under general anaesthesia with orotracheal intubation. METHODS This interventional study compares the incidence of post-operative sore throat and hoarseness of voice after endotracheal intubation on applying betamethasone gel (betamethasone group) or lignocaine jelly (lignocaine group) on the tracheal tube. 120 American Society of Anaesthesiologist (ASA) class I and class II patients who had undergone elective surgeries under general anaesthesia were divided into two groups: betamethasone group and lignocaine group. All patients were enquired on post-operative sore throat and hoarseness of voice at 1, 6 and 24 hours after extubation in the post-anaesthesia care unit. RESULTS The incidence of no sore throat, mild, moderate and severe post-operative sore throat at 24 hours after extubation in betamethasone group was 75.0 %, 23.3 %, 1.7 % and 0 % respectively compared to lignocaine group which was 33.3 %, 53.3 %, 6.7 % and 6.7 % respectively (P value < 0.05). The incidence of sore throat was found lower in the betamethasone group than in lignocaine group at intervals 1, 6, 24 hours post extubation with P value < 0.05. The incidence of no HOV, grade 1 HOV, grade 2 HOV and grade 3 HOV in betamethasone group was 46.7 %, 48.3 %, 5.0 % and 0 % respectively compared to lignocaine group which was 25.0 %, 46.7 %, 25.0 % and 3.3 % respectively with P value < 0.05. CONCLUSIONS This study proves that betamethasone gel, when used for lubrication of endotracheal tube pre-operatively, has shown to be effective in decreasing postoperative sore throat and hoarseness of voice. KEYWORDS Betamethasone, Lignocaine, Sore Throat, Hoarseness of Voice, Endotracheal Intubation
Study of Role of Optical Coherence Tomography in the Interpretation of Common Macular Disorders at a Tertiary Eye Care Centre in Rural Maharashtra
Authors: Nisale Uttam Haribhau , Dhakne Varsha Ramesh , Karad Sourabh Hanumant , Waghambare Samarth Babasaheb , Karad Hanumant Tulshiram , Karad Madhuri Tejas , Pujar Rajlaxmi Suhas , Ambade Harshal Sushil
Published: September 2021

BACKGROUND Optical Coherence Tomography (OCT) is a commonly used non invasive imaging instrument useful for the diagnosis and follow up of macular disorders, but it has its own share of drawbacks in the presence of media opacities like corneal oedema, dense cataract and vitreous haemorrhage. We wanted to study and interpret the various patterns of common macular diseases on optical coherence tomography. METHODS 100 patients having macular diseases with no other ocular pathology were selected by simple random sampling. The patients were studied and followed up from day 1 of OPD during the period from January 2019 to December 2019 in rural hospital at Latur. All patients suspected of any macular disorder by slit lamp bio-microscopy with 78D or 90D examination were subjected to OCT evaluation. RESULTS On observation, out of 100 cases of macular pathology, 44 % (44 patients) with age related macular degeneration(ARMD), diabetic macular oedema ( DME) 36 % (36 patients), central serous retinopathy (CSR) 10 % (10 patients), myopic maculopathy (MM) 7 % (7 patients), macular hole (MH) 3 % (3 patients) were found in our study. In ARMD patients our OCT findings were hard drusens in retinal pigment epithelium (RPE), detachment of neurosensory retina and retinal pigment epithelium whereas in patients of DME our OCT findings were cyst like hyporeflective spaces within the retina, with retinal thinning and loss of foveal depression. In patients of CSR our findings were separation of sensory retina from RP, in myopic maculopathy our OCT findings were presence of macular retinoschisis and in patients of MH our findings were showing attachment of the posterior hyaloids to the fovea, separation of a small portion of the sensory retina from RPE in the foveolar region and intraretinal cystic changes. CONCLUSIONS OCT plays a crucial role when added along with the clinical examination in the diagnosis and interpretation of common macular disorders. KEYWORDS Optical Coherence Tomography, Age Related Macular Degeneration, Macular Hole, Myopic Maculopathy
Effects of Thyroid Function on Blood Cell Counts and Red Cell Indices – A Retrospective Study at a Tertiary Care Centre in Mandya, Karnataka
Authors: M.S Siddegowda , R Chaithra , S Shivakumar , C.M Maithri
Published: September 2021

BACKGROUND Thyroid hormones play an important role in the regulation and production of red blood cells. Thyroid dysfunction induces different effects on blood cells such as anaemia, erythrocytosis, leucopenia, thrombocytopenia and alteration in red cell indices. In this study, we wanted to compare the changes in haematological parameters of thyroid dysfunction patients with those of euthyroid group. METHODS This was a retrospective study done on 310 individuals by collecting data from the medical records. Later the patients were categorized into hypothyroid (33) thyroid stimulating hormone (TSH > 5.5 μIU/mL), hyperthyroid (19) (TSH < 0.3 μIU/mL) and euthyroid (258) (TSH = 0.3 - 5.5 μIU/ml) groups. The haematological parameters of all these patients were obtained by 5-part automated cell count analyser. Finally, the obtained data was analyzed by statistical package for social sciences (SPSS) software. RESULTS The data obtained from the analysis revealed statistically significant (P < 0.05) difference between hypothyroidism, hyperthyroidism and euthyroidism in mean red blood cell (RBC) count, mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH), red cell distribution width (RDW), white blood cell (WBC) count and platelet count but the difference was not significant for mean haemoglobin, mean corpuscular haemoglobin concentration (MCHC) (P > 0.05). The mean haemoglobin was lower in hypothyroid patients when compared to euthyroid and hyperthyroid patients. The RBC count (P < 0.007), MCH (P = 0.002) and RDW (P < 0.001) showed statistically significant difference between hypothyroidism and euthyroidism, MCV (P = 0.005) showed statistically significant difference between hyperthyroid and euthyroid groups. CONCLUSIONS In case of patients with abnormal haematological parameters, thyroid hormones evaluation is necessary. KEYWORDS Hypothyroidism, Hyperthyroidism, Haemoglobin, Blood Count, Red Cell Indices
Efficacy and Safety of Intravitreal Injection Ranibizumab versus Triamcinolone Acetonide in Diabetic Macular Oedema - A Prospective Randomized Study, Gorakhpur, Uttar Pradesh
Authors: Yadav Ramyash Singh , Jaiswal Ram Kumar , Tripathi Punita , Ranjan Mridula , Rai Chiranji
Published: September 2021

BACKGROUND Diabetic macular oedema is a sight threatening complication of diabetic retinopathy. Vascular endothelial growth factor (VEGF) plays an important role in developing diabetic macular oedema. There are many treatment options available for diabetic macular oedema such as laser therapy, intravitreal injectable medications like anti-VEGF and steroids. This study intends to compare the efficacy and safety of intravitreal injection Ranibizumab (anti-VEGF) and Triamcinolone acetonide (steroid) in diabetic macular oedema. METHODS This is a prospective randomized study conducted among 42 patients ≥ 18 years of age with diabetic macular oedema presenting to outpatient department in a tertiary care centre in Gorakhpur, UP, conducted from November 2019 – December 2020. 42 participating patients were divided into 2 groups, A and B with 21 patients in each group. Group A treated with intravitreal injection Ranibizumab (0.05 ml ; 0.50 mg) and group B treated with intravitreal injection Triamcinolone acetonide (4 mg in 0.1 ml). All patients were followed-up at 2 week and 4 week after injection for best corrected visual acuity, intraocular pressure, foveal and para-foveal thickness. Optical coherence tomography was performed for measuring foveal and para-foveal thickness. RESULTS The mean age group being 56.48 years in group A and 58.63 years in group B with 12 male and 9 female patients in group A and 10 male and 11 female patients in group B with no dropout during study period. Both injections were equally effective in reducing foveal and para-foveal thickness and improving best corrected visual acuity. Intraocular pressure (IOP) was stable in Ranibizumab treated group but Triamcinolone treated group showed raised IOP in few patients, required anti-glaucoma medications. CONCLUSIONS Both treatment types had good efficacy in reducing foveal and para-foveal thickness and thus improving best corrected visual acuity, but intravitreal Ranibizumab is safer and well tolerated along with good efficacy in patients with diabetic macular oedema. KEYWORDS Best Corrected Visual Acuity, Diabetic Macular Oedema, Foveal and Para-Foveal Thickness, Intravitreal Ranibizumab, Intravitreal Triamcinolone Acetonide
Comparison of Safety and Efficacy of Grid Laser Versus Combination of Sequential Intravitreal Triamcinolone Acetonide and Grid Laser in Treatment of Diabetic Macular Oedema - Randomized Open Label Study, Bangalore, Karnataka
Authors: S Shashidhar , Kasbe Sachin M. , Nayak Adhar V. , D Shivakumar
Published: September 2021

BACKGROUND The reported prevalence of diabetic retinopathy in diabetics is around 40 %. Diabetic macular oedema (DME) is defined as macular thickening resulting from diabetic retinopathy, due to leakage from micro aneurysms, or from a diffuse leakage of hyper permeable capillaries. Intravitreal injection of triamcinolone acetonide (IVTA) has gained considerable interest and clinical use because it often has beneficial effect on retinal thickening in DME. The synergistic action of IVTA and laser photocoagulation might increase and prolong the beneficial effects of IVTA in reducing ME. Hence the need for a study to compare efficacies of grid laser, and combination of sequential IVTA and grid laser in treating patients with DME. We wanted to evaluate functional and morphological outcome of grid laser versus combination of sequential intravitreal triamcinolone acetonide and grid laser in treatment of diabetic macular oedema. METHODS The study included 62 eyes with DME. There were 31 eyes which received grid laser photocoagulation (group 1) and 31 eyes which received grid laser photocoagulation following IVTA (group 2) and visual acuity, CMT on OCT was compared at baseline and after day 1, 1st week, 4th week and 12th week. Outcome and comparative efficacies were evaluated. RESULTS Our study shows reduced macular thickness and improved visual acuity in group 2 compared to group 1 in all follow ups. On intragroup analysis, we found a significant reduction in CMT in both groups at 1 week, 4 weeks and 12 weeks as compared to baseline. In our study we also compared CMT between group 1 and group 2 which did not show significant difference at baseline. But, difference in CMT from baseline at each follow up which is at 1 week, 4 weeks and 12 weeks between two groups showed more reduction in CMT in group 2 compared to group 1. CONCLUSIONS There was a significant reduction in CMT in all the follow ups of both groups, but group 2 had more reduction in CMT compared to group 1. The synergistic action of IVTA and laser photocoagulation might increase and prolong the beneficial effect of IVTA in reducing ME. This study found evidence of synergistic effects of IVTA and laser photocoagulation in DME in terms of improving visual acuity and in reducing CMT compared to grid laser alone and should be tried as a modality of treatment in DME. KEYWORDS DME, IVTA, CMT, Macular grid laser, OCT
A Cross Sectional Study of Incidence of Alcohol Consumption in Patients Admitted with Traumatic Injury in the Department of Surgery, Maharaja Yashwant Rao Hospital, Indore
Authors: Sodhiya Paresh , Hurmade Khushal Rao , Mahajan Sanjay , Dandotiya Gajendra , Das Manisankar , Ghanghoria Arvind
Published: September 2021

BACKGROUND The number of trauma cases is increasing day by day in our setup. Daily 10-15 patients of trauma came to MYH, we found that among these patients many patients have under the influence of alcohol. Alcohol consumption is the leading cause of trauma and reason for visitation to emergency department. We wanted to prospectively study the incidence of alcoholism in victims of trauma admitted in Dept of surgery, MYH Indore and correlate the severity of trauma in relation to blood alcohol concentration. METHODS This cross sectional study conducted at Maharaja Yashwant Rao Hospital from January 2019 to march 2020 and it includes all patients 16 years and above with traumatic injury admitted in Department of Surgery. Breath analyzer test will be done on all patients and levels will be documented. RESULTS In our study head injury (73.6 %) was the most common type of injury in which breath analyzer testing was found positive in 82 %,followed by burn (12.7 %) in which breath analyzer testing was found positive in 2.1 %, followed by poly trauma (4 %) in which breath analyzer testing was found positive in 4.3 %, followed by blunt trauma chest (2.4 %) in which breath testing was found positive in 2.7 %, followed by limbs (0.7 %) in which breath analyzer testing was found positive in 0.9 %. CONCLUSIONS In our study we have found that out of total 3105 patients history of alcoholism is present in 1420 patients while breath alcohol analyzing test positive in 2072 patients and there is significance relationship between trauma and history of alcoholism with the p value of <0.0001. We also found that significant relationship between trauma and breath alcohol analyzing testing with the p value of <0.0001. KEYWORDS Glasgow Coma Scale, Blood Alcohol Concentration, Road Traffic Accidents, Emergency Department, Breath Analyzer
Utility of Blood Markers in Early Prediction of Bacteraemia in Acute Febrile Paediatric Patients – An Observational Cohort Study in a Tertiary Care Hospital of North India
Authors: Bhunia Rabindra , Nair Bindu T. , Negi Vandana
Published: September 2021

BACKGROUND Bacteraemia is a common cause of children presenting to the paediatric emergency with acute febrile illness. Blood cultures remain the gold standard for detection of bacteraemia but the positivity is low and also takes time to show positive results. A rapid and reliable biomarker like procalcitonin (PCT), C-reactive protein (CRP), total leucocyte count (TLC), and neutrophil-lymphocyte count ratio (NLCR) can be used to identify febrile children with greater risk for bacteraemia or serious bacterial infections. This would be very helpful to start early treatment of bacteraemia with antibiotics. METHODS The study was an observational cohort study conducted in the Department of Paediatrics of a tertiary care hospital in North India in children between age group 6 months to 12 years presenting with fever of > 100.4° F for 2 - 7 days. Blood samples were sent for PCT, CRP, TLC, NLCR and blood cultures. RESULTS The most sensitive biomarker was total leukocyte count (47.36 %) followed by the neutrophil percentage (26.32 %), C-reactive protein (21.05 %), and procalcitonin (15.79 %). The most specific biomarker was procalcitonin (75.14 %) followed by C-reactive protein (58.56 %), neutrophil percentage (22.65 %) and total leukocyte count (11.05 %). The only biomarker that was statistically significant between the bacteraemia and non-bacteraemia group in the present study was total leukocyte count (P – value < 0.05). CONCLUSIONS The sensitivity and specificity of each single biomarker is low and hence these cannot be used singly to predict bacteraemia. There should be a combination of biomarkers with adequate sensitivity and specificity that can be used to create an algorithm to aid in diagnosis and prognostication. KEYWORDS Procalcitonin, C-Reactive Protein, Blood Culture, Acute Febrile Patient
Poncet’s Disease – A Commonly Missed Diagnosis
Authors: Gupta Puneeta , Raina Rohit
Published: September 2021

Tuberculosis (TB) is the leading cause of mortality among infectious diseases with estimated 1.5 million deaths from TB in 2018 -19 and presented as a public health concern. In 1897, the Frenchman Antonin Poncet first described Poncet's disease (PD) as a rare syndrome, where polyarthritis in an acute stage of TB, resolved without joint damage. Similar reports on patients of tuberculosis and joint pain led authors to improve the definition, and in 1978, PD was described as a para infective arthritis by Bloxham and Addy. Regardless of its doubtful existence, cases have been continued to be reported over the years. Poncet's disease is a form of reactive arthritis which is characterized by articular affection in patients diagnosed with TB where there is immune reaction to the tuberculous protein but there is no direct invasion by the micro-organism.1,2 PD is to be differentiated from tuberculous arthritis where there is monoarticular and direct tubercular involvement of the joint. Before more obvious features develop, the sole manifestation of the disease is joint involvement. Crippling pain is experienced during polyarthritis which limits the mobility and activities of patients. Polyarthritis can also occur in common causes such as rheumatological diseases as a symptom and thus can be easily misdiagnosed. Polyarthropathy, that is multiple large and small joints involvement in the body, is the one of the rarest presentations in both active pulmonary and extrapulmonary tuberculosis. This polyarticular impairment observed in patients with active TB, a form of reactive arthritis is known as Poncet’s disease. Since there is no direct bacillary invasion of the joints, it is an aseptic form of arthritis. It is not to be confused with tuberculous arthritis, which is usually monoarticular and where there is direct tuberculin infection. Poncet's disease remains a diagnosis of exclusion. Since case reports are very rare even in countries where tuberculosis is common thus no accepted diagnostic criteria is set for Poncet's disease. This diagnostic possibility becomes increasingly important as the use of corticosteroids, immune suppressants or biologicals can risk further dissemination of the disease. We describe the case of a 50-year-old woman, who presented with active tuberculosis where polyarthralgia was the first and only symptom for four months. Polyarthritis patients were being treated with both non-steroidal anti-inflammatory drugs and antitubercular therapy and to the surprise patients with antitubercular treatment had complete resolution of symptoms after 6-week therapy whereas non-steroidal anti-inflammatory drugs (NSAIDS) offer no benefit. The total duration of therapy was 6 months.
Aetiological Outcome of Mesenteric Lymphadenopathy and Pain Abdomen in Paediatric Population at a Tertiary Care Hospital (MRIMSHyderabad) - A Hospital Based Prospective Observational Study
Authors: Allagadda Dileep Kumar , Appana Harikrishna , Pedada Ramu , Gurram Deepika , Joseph Ditin
Published: September 2021

BACKGROUND Abdominal pain is a common disorder in children and adolescents worldwide with prevalence rate ranging from 20 - 25 % in school-going children in India. It is a frustrating concern to the child, parents and the physician. Even though abdominal pain is one of the most common complaints in children, it poses a diagnostic challenge owing to the variety of underlying causes. The purpose of this study was to evaluate the aetiology of abdominal pain associated with significant mesenteric lymphadenopathy in a paediatric population. METHODS This is a hospital based prospective, observational study done in Department of Paediatrics, Malla Reddy Institute of Medical Sciences (MRIMS), Hyderabad. RESULTS Out of the 65 children studied, 30.8 % were of 5 - 8 years age group, 36.9 % were 9 - 12 years age group and 32.3 % were 13 - 15 years age group. In our study, we found 50.8 % were boys and 49.2 % were girls. 20 % of them were having fever, 16.9 % were having cough, 16.9 % were having diarrhoea, 13.8 % were having sore throat, 16.9 % dysuria, and 15.4 % were having constipation. All patients in our study group underwent ultrasound of abdomen. All cases were having significant mesenteric lymphadenopathy (more than 5 mm in short axis with three or more number of lymph nodes). In 53.8 % cases, etiological agent for the mesenteric lymphadenopathy was not proved with our investigations. In the remaining 46.2 % of children, cause of mesenteric lymphadenopathy was proved and 38.5 % were bacterial infections, 6.2 % were viral infections and 1.5 % were parasitic infections. CONCLUSIONS It is important to recognise mesenteric lymphadenitis as a clinical entity in paediatric cases presenting with abdominal pain. They should be evaluated for an etiological agent and if no proven source of infection and etiological agent is found, it can be considered as functional abdominal pain. If we are able to get a proper etiological diagnosis in these cases, we could treat them and we could make huge difference in terms of quality of life. KEYWORDS Abdominal Pain, Mesenteric Lymphadenitis, Ultrasound, Significant Mesenteric Lymphadenopathy
Ocular Surface & Tear Film Changes in Patients Undergoing Small Incision Cataract Surgery - A Hospital Based Prospective Clinical Study in South Kerala
Authors: Rajagopal Arya Amala , Mathew Mini
Published: September 2021

BACKGROUND Dry eye is an important factor affecting the quality of life especially elderly. The major cause of adult blindness in India is cataract. After cataract surgery many are beleaguered by dry eye symptoms. Since small incision cataract surgery remains the most commonly performed surgical procedure for cataract in India the ocular surface and tear film changes occurring in patients after cataract surgery in our hospital was studied. METHODS A prospective observational study was conducted among 120 patients who underwent uncomplicated cataract surgery at RIO, Thiruvananthapuram for a period of 12 months from July 2019 - June 2020 to assess the changes that occur in ocular surface and tear film after small incision cataract surgery. The dry eye status was measured using Schirmer tests, tear film breakup time, tear film height, fluorescein and lissamine green staining and finally graded using OSDI score. The score was assessed preoperatively & postoperatively at 1 week, 4 weeks & 12 weeks. RESULTS Pre & postoperative OSDI score showed that 1 week after surgery only 5 % patients remained with no dry eye changes. 4 weeks after the surgery mild dry eye was found in 35 %, moderate dry eye in 40 % & severe dry eye in 23 % patients. 12 weeks after surgery mild dry eye was found in 53.3 %, moderate in 33.3 % & severe in 1.7 %. The occurrence of dry eye was seen to increase 1wk postoperatively & peak around 4weeks postoperatively. CONCLUSIONS Small incision cataract surgery induces significant dry eye changes in patients whose ocular surface & tear film was normal preoperatively. The dry eye changes were noted to worsen maximum at 4 weeks after surgery & these changes persisted in low grade even at 12 weeks after surgery. KEYWORDS Dry Eyes, Small Incision Cataract Surgery (SICS), OSDI (Ocular Surface Disease Index) Score
Erdheim-Chester Disease - Multisystemic Radiological Manifestations
Authors: Nagaraju Rashmi Mysore , Bhimarao Bhimarao
Published: September 2021

Erdheim-Chester disease (ECD) is a rare, multisystem disorder with a constellation of clinical and radiological findings. We present a case of ECD who came with acute obstructive uropathy and chronic bone pain. Radiological work up in this patient led to a host of findings in various systems, the correlation of which led to narrowing of the differential diagnoses. A 44-year-old male presented with right loin pain and nausea for 1-day duration. A provisional diagnosis of right ureteric colic was made. Routine lab investigations revealed normal total counts and urine analysis. Additional laboratory investigations revealed a raised erythrocyte sedimentation rate (ESR) and Creactive protein (CRP). Radiological Investigations 1. Patient was referred for ultrasound of abdomen which revealed mild to moderate right hydronephrosis with a suspicious hypoechoic area (~ 0.7 x 1.2 cm) in the renal pelvis region raising possibility of a lesion. 2. Contrast computed tomography (CT) study of abdomen was performed which revealed enhancing soft tissue infiltration (+30 to +45 HU) around bilateral kidneys (giving ‘hairy kidney appearance’) (Figures 1, 2 & 3) and adrenal glands with infiltration to renal sinus and constriction of bilateral renal pelves resulting in moderate right and mild left hydronephrosis. Thin streak of excreted contrast was traversing the narrowed segment of renal pelves (Figures 4 & 5). 3. Soft tissue infiltration covering the visualized thoracic and abdominal aorta (giving ‘coated aorta appearance’) (Figures 6 & 7), extending below renal arteries to aortic bifurcation and proximal bilateral common iliac arteries. 4. The adrenal glands were not separately visualized from the above mentioned perinephric soft tissue. 5. Both ureters were normal in course and caliber. No evidence of ureteric calculus. 6. No significant retroperitoneal lymphadenopathy. 7. Few tiny centriacinar nodules with patchy ground glass opacities in postero basal segment of both lungs (left > right) (Figure 8).
Serum Sodium Level and Its Correlation with Curb-65 Score in Community Acquired Pneumonia – A Study from Bangalore, India
Authors: Rajanna Avinash Hanbe , Rajoli Swetha , Gurav Nitish Ashok
Published: September 2021

BACKGROUND Community acquired pneumonia (CAP) refers to pneumonia contracted by a person with little or no contact with health care system. Severity scores like CURB 65 severity score are useful in estimating the outcome. Hyponatremia is defined as serum sodium level < 135 mEq/L. The incidence of hyponatremia at hospital admission among CAP patients is found to be 28 %and the mechanism behind it has been found to be due to syndrome of inappropriate antidiuretic hormone secretion (SIADH). Hence this study is an effort to explore how hyponatremia is associated with severity and outcomes, in hospitalized patients with pneumonia. The purpose of this study was to assess the proportion of hyponatremia in patients with community acquired pneumonia and compare hyponatremia with CURB-65 as an initial screening tool for assessment of severity of CAP. METHODS This is a hospital-based cross-sectional study. 75 community acquired pneumonia patients admitted as inpatients are included in this study. Information is collected and detailed history is taken using pre-formed proforma at the time of admission. Serum sodium levels were measured, after initial assessment of patients. The lab values of serum sodium levels were analysed with the clinical profile and outcome in these study groups. RESULTS In our study, it was observed that as the sodium levels are decreasing, the CURB 65 score increases. Study subjects who had sodium levels < 125 mg/dl, presented with CURB 65 score as 4 (30 %). Inversely, the study subjects with high sodium levels (> 135 mg/dl) had CURB 65 scores as 1 (75 %). The association between sodium levels and CURB 65 score was significant in patients who got discharged but not in patients who expired. CONCLUSIONS Present study of serum sodium levels as biomarkers in CAP showed that hyponatremia carried poor prognosis which correlated with high CURB 65 score. KEYWORDS Sodium, Community Acquired Pneumonia, SIADH, CURB 65, Hyponatremia, COPD
A Comparative Study on the Diagnostic Utility of Creatine Kinase-MB (Myocardial Band) Mass Estimation Over Its Activity Measurement in Patients with Acute Myocardial Infarction in a Tertiary Care Hospital in Puducherry
Authors: Kumar Nikhila Suresh , Rajendran Sivaa , Nanda Sunil Kumar , Christopher Mark , Kandasamy Ravichandran
Published: September 2021

BACKGROUND Cardiovascular diseases (CVDs) are one of the major health problems and leading cause of death worldwide. Acute myocardial infarction (AMI) is one of the cardiovascular diseases which has high mortality in early hours of presentation and hence early and accurate diagnosis is important to reduce the morbidity and mortality. Troponin I and CKMB (Creatine Kinase-Myocardial Band) activity are the routine biomarkers used for early diagnosis of AMI. Since there is a high degree of instability in the measurement of CKMB activity and also there are frequent noncorrelation with the Troponin I levels, we aimed to estimate and compare the levels of CKMB mass and CKMB activity in patients with and without AMI. METHODS This comparative study included 40 cases and 40 controls. Cases were adult patients between the age group of 30 -70 years diagnosed with AMI by electrocardiogram (ECG) and positive troponin I, and controls were who presented with non myocardial infection (MI) chest pain. Blood samples were collected to estimate CKMB activity and CKMB mass. RESULTS The median value of CKMB activity in controls was 21 IU/L (IQR 13.25-27.75) and that in cases was 40 IU/L (IQR 30.25-94.25) and this difference is statistically significant. The median value of CKMB mass in controls was 5 ngmL (IQ 4-6) and that in cases was 19.50 ng/mL (IQR 6-61.50) which is also statistically significant in differentiating both. In Spearman correlation test, both showed a better statistical significance and correlation in cases (r = 0.787). It was evident that the median value of CKMB activity in controls was higher than that of the normal range for CKMB activity which is 8-16 IU/L, but the median value of CKMB mass in controls was well within the normal range of 5- 10 ng/mL, considering it to be a better marker for eliminating false positive results. CONCLUSIONS CKMB mass can be considered as a better marker than CKMB activity for accurate diagnosis of AMI along with troponin I. KEYWORDS Cardiovascular Diseases, Biomarker, Acute Myocardial Infarction, CKMB Mass, CKMB Activity
Multidetector-CT Profile of Benign and Malignant Neck Masses among Patients of Guwahati, Assam
Authors: Virupakshappa Anil Kumar Geetha , Kumar Ashok , Lokanatha Sushma Kenkare
Published: September 2021

BACKGROUND Multidetector computed tomography (MDCT) is the imaging of choice and the most commonly used investigation in head and neck lesions, because of its fast and readily available nature. Our study focused on contrast enhanced multidetector CT profile of neck masses in determining their nature among different demographic profile. It provides volumetric helical data, optimal multiplanar and 3D reconstructions. METHODS This is a retrospective observational study carried out in the Department of Radiology, Gauhati Medical College and Hospital, Guwahati, among 60 cases of clinically diagnosed neck masses, from December 2011 to June 2013. All patients were selected from out-patient departments (OPD) and indoor wards of various departments (mostly from ENT department). Few cases were also taken from Dr. B. Baruah Cancer Institute. Patients from both sexes and all ages were included as part of the study. Chi square test/Fischer exact test have been used to find the significance of association of CT scan findings with the final diagnosis. Diagnostic statistics such as sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy have been used to find the correlation of CT scan with the final diagnosis. RESULTS Thin slice scanning with thinner reconstructions, maximum intensity production (MIP), shaded surface display (SSD), multiplanar reformation (MPR) and curved reformatted images are the advantages of MDCT. CT has 100 % accuracy in bony involvement detection and 96 % accuracy in neck lesion diagnosis. Therefore, CT can accurately localise and characterise the neck lesions. CONCLUSIONS The neck lesion location and its characteristics determination has significantly improved because of computed tomography. Bone erosions and expansion are accurately determined by a CT scan. CT scan can accurately delineate the disease that provides a definite pre-operative diagnosis, planning radiotherapy ports and post therapy follow up. KEYWORDS Bone Invasion, Lymph Nodes, Neck Space Extensions, Multidetector-CT
An Epidemiological Assessment of Endometrial Carcinoma Including Demographics and Histopathological Correlation, from a Tertiary Care Teaching Hospital in South India
Authors: Babu Jeenu , Pulinilkunnathil Reeba George , Kumar Bindu R.
Published: September 2021

BACKGROUND Endometrial cancer (EC) is also the second most common gynaecologic malignancy in developing countries, with an incidence of 5.9 per 100,000 women. Due to the multiple modifiable factors, a better understanding of the prognostic indicators can lead to early detection and treatment. The purpose of this study was to evaluate the frequency and the distribution of various risk factors, epidemiological factors, and histological patterns of patients diagnosed with endometrial carcinoma in a tertiary teaching hospital in south India and compare them with similar studies. The compiled findings of 60 consecutive cases that presented to our tertiary care teaching hospital in Kerala, south India, over oneand-a-half-year period were studied. METHODS This study was essentially an ex post facto retrospective study done on 60 patients for one and half years. Retrospective data collection and compilation were done with previously prepared structured questionnaires in patients with histologically proven endometrial carcinoma. All cases were subjected to hysterectomy with post-surgical histopathology correlation. A study of the risk factors, general epidemiological characteristics, endometrial biopsy findings, and post-surgical histopathology was done. RESULTS The mean age at presentation was 59.83 years. The mean age of menarche was 13.72 years, and menopause was 49.42 years. The majority of patients were married, multiparous, and presented with bleeding per vaginum (77 %). 61.7 % of the patients had a history of hypertension, 31.7 % had a history of hypothyroidism, and 43.3 % had a history of diabetes mellitus in the study population. The most common histopathological type by endometrial biopsy and histopathological correlation was endometrioid adenocarcinoma (88.3 %). CONCLUSIONS Postmenopausal age group, with early menarche and late menopause, high body mass index (BMI), thickened endometrium on ultrasound, and atrophic uterus were some of the features associated with endometrial carcinoma. The most common histological subtype was found to be endometrioid carcinoma KEYWORDS Endometrial Carcinoma, Risk Factors, Prognostic Indicators
Morbidity Pattern and Its Determinants in Urban Field Practice Area of VIMS, Bellary - A Cross-Sectional Study
Authors: Reddy Pratibharani , K Ramesh , Jacob Anju Mariam , T Gangadhara Goud
Published: September 2021

BACKGROUND India is doubly burdened with communicable and non-communicable diseases (NCD). Knowledge regarding morbidity profile is important for timely intervention so as to improve the quality of life. For effective health strategies, it is important to know the disease burden of a community. As for the effective preventive strategies, it’s important to know the information regarding disease burden and changing trends of diseases in the locality. Hence this study was done to find the morbidity pattern of urban population in Bellary district, Karnataka. METHODS A cross sectional study was carried out in Millerpet, urban health training centre (UHTC), Bellary, Karnataka. The respective UHTC covers 69195 populations, which has eight wards. Simple random sampling technique was adopted to select the ward. The study was carried out in the selected ward and the study duration was for a period of 3 months. Based on the estimated sample size, 416 houses were selected using random number method. Statistical package for social sciences (SPSS) software version 26 was used for analysing data. Descriptive statistics were used to describe socio demographic and morbidity conditions. RESULTS The most common morbidity among 416 houses were found to be diabetes (22.8 %) followed by hypertension (20 %) and musculoskeletal problems (9 %). Majority of the houses were of nuclear type and the most common age group was 31 - 60 (91.8 %) years followed by 13 - 30 years (80.8 %). 167 (40.1 %) houses had at least one morbidity and 451 (41.4) subjects had at least one morbidity. Socio-demographic variables like age group, family size, monthly income, occupation of head of the family and type of the family were found to be statistically significant. CONCLUSIONS The study revealed that non communicable are the most common diseases present and there is a need to further evaluate the factors responsible so that preventive measures can be taken at the earliest so as to improve the quality of life. KEYWORDS Morbidity Pattern, Urban, Bellary
Patient Prosthesis Mismatch in Double Valve Replacement - A Retrospective Study at a Tertiary Care Center in Bangalore
Authors: N Bharathguru , Mallikarjun Divya , Joshi Shreedhar S. , Suresh Shilpa , Kamalapurkar Giridhar
Published: September 2021

BACKGROUND Valve replacement has become the mainstay of management for rheumatic heart diseases. However, an important and frequent complication of valve replacement is patient prosthesis mismatch (PPM). The present study was undertaken to evaluate a single institution experience on the clinical pattern and presentation of PPM, and the outcomes of double valve replacement surgery. METHODS This retrospective, regional study was carried out among 316 consecutive patients who underwent concomitant aortic and mitral valve surgery (with or without tricuspid annuloplasty) in this tertiary care hospital. Particulars regarding the clinical profile and procedure details (valve types and sizes and priority of surgery) of these patients were documented from the medical records. RESULTS In this institute, the valves used were predominantly mechanical (92.6 %) when compared to bioprosthesis in 7.4 % (47/632 valves - 23 mitral position and 24 in aortic position). The most common sizes used in the aortic and mitral position were 21 mm & 27 mm respectively. In spite of the seemingly lower sizes used in the patients undergoing double valve replacement (DVR) the incidence of PPM is less owing to the fact that the population under study had a lower body surface area (BSA) and body mass index (BMI) - 1.17 ± 0.3 & 19.86 ± 3.9 respectively. CONCLUSIONS It may be emphasized that if the valve size required to be implanted is derived based on the patient’s BSA and indexed effective orifice area, the incidence of patient prosthesis mismatch can be minimized drastically and with it the in-hospital mortality and morbidity. KEYWORDS Aortic Stenosis, Double Valve Replacement, Mitral Valve, Prosthesis, Rheumatic Heart Disease
Clinical Outcome of CO2 Laser Inferior Turbinate Reduction in Patients with Nasal Obstruction Due to Inferior Turbinate Hypertrophy in a Tertiary Care Centre, Thiruvananthapuram, Kerala
Authors: Rajendran Nikhila , C Jaya , M Venugopal , S Satheesh
Published: September 2021

BACKGROUND Nasal obstruction secondary to inferior turbinate hypertrophy significantly affects the quality of life. Patients refractory to medical treatment are taken up for surgery. Laser turbinate reduction is an effective and simple method for treatment of nasal obstruction due to inferior turbinate hypertrophy. Only a few studies reported on the outcome of laser inferior turbinate reduction in India. The present study was done to assess the clinical outcome of laser inferior turbinate reduction in patients with nasal obstruction due to inferior turbinate hypertrophy. METHODS This prospective observational study was done in 31 patients (18 – 60 years) with nasal obstruction due to inferior turbinate hypertrophy refractory to medical management who underwent laser inferior turbinate reduction in ENT Department, Government Medical College, Thiruvananthapuram from December 2017 to September 2019. RESULTS All patients had bilateral inferior turbinate hypertrophy. 21 out of 31 patients had allergic rhinitis and rest had non-allergic rhinitis. Pre-operatively most patients had symptom score between 15 and 20. After CO2 laser inferior turbinate reduction at the end of 3 months of follow up, subjective assessment by symptom scoring confirmed by objective assessment by flowmetry 29 out of 31 patients had good outcome with relief from nasal obstruction. The success rate was more in nonallergic rhinitis (100 %) than the allergic rhinitis group (90.47 %). CONCLUSIONS CO2 laser inferior turbinate reduction is an effective procedure to relieve nasal obstruction in patients with inferior turbinate hypertrophy refractory to medical treatment, with minimal complications. Post-procedure on follow up significant number of patients had relief from hyposmia, sneezing and running nose. KEYWORDS Nasal Obstruction, Peak Nasal Inspiratory Flowmetry, Symptom Scoring, CO2 Laser, Outcome
A Study to Assess the Effect of Maternal Obesity on Pregnancy Outcome in a Tertiary Medical Centre of South Bihar
Authors: Aishwarya Aishwarya , Praveen Arshi , Singh Vineeta
Published: September 2021

BACKGROUND World health organization (WHO) declares obesity as a pandemic issue, having high prevalence in females, especially in the childbearing age than in males. Pregnancies complicated by obesity has been identified as early as 1945. Prepregnancy obesity endangers both maternal and fetal well-being. Increasing body mass index (BMI) is associated with increased adverse obstetric and fetal outcomes. Pre-pregnancy obesity and excessive gestational weight gain are parts of maternal obesity during pregnancy. Prenatal maternal obesity and excessive gestational weight gain also improve placental nutrition transfer to the developing foetus and foetal development. The purpose of this study was to evaluate the association between early pregnancy BMI and maternal complications as well as labour outcome. METHODS A prospective observational study comprising 250 antenatal women with singleton uncomplicated pregnancies, booked at Narayan Hospital, Rohtas, South Bihar within the first 12 weeks of gestation were selected for the study. The following inclusion and exclusion criteria were considered. With the help of a predesigned questionnaire, basic information including weight and height was collected in the first check up and BMI was calculated accordingly. BMI was calculated using the formula weight (kg)/height 2 (m2). RESULTS The mean age of mothers was 25.98 ± 3.92 years. Mothers who underwent caesarean section had BMI of 27.36 ± 5.768 and for normal vaginal delivery mothers it was 27.94 ± 6.076, whereas for mother who had undergone forceps delivery, BMI was 30.60 ± 3.864 whereas for other assisted vaginal delivery it was 29.75 ± 7.246. There is mild correlation of BMI of mother to the birth weight of baby. On applying regression analysis, we found mild correlation with R square 0.134. There was no correlation of BMI of mother to the hospital stay of their children. CONCLUSIONS We concluded that however statistically there is no significant association between obesity and numerous maternal and perinatal risks in obese pregnant women but it poses a considerable challenge to the obese patient in successful completion of pregnancy. KEYWORDS Obesity, BMI, Pregnancy Outcome, NICU, Mode of Delivery
CT Imaging of Primary Lung Tumours with CT Guided Fine Needle Aspiration Cytology Correlation among Guwahati, Assam Population
Authors: Kumar Ashok , Virupakshappa Anil Kumar Geetha , Lokanatha Sushma Kenkare
Published: September 2021

BACKGROUND The primary lung masses (tumours) are those that originate from the lung tissue. Although most primary pulmonary tumours are carcinomas, a large histological spectrum of benign and malignant tumours of the lung exists. Although chest xray is still considered to be the primary imaging modality of lungs, computed tomography (CT) not only shows the segments that are involved but also the extent of involvement. We wanted to study the sensitivity and specificity of CT in the diagnosis of primary neoplastic lesions of lung, study the CT patterns of different histological variants of bronchogenic carcinoma, and correlate CT findings with CT guided fine needle aspiration and cytology (FNAC) findings. METHODS The present descriptive cross-sectional study was conducted among 34 patients suspected clinically of having lung neoplasms, in Gauhati Medical College and Hospital, Guwahati, Assam from December 2010 to November 2011. RESULTS Considering FNAC / histopathological examination (HPE) as the gold standard, the positive predictive value and false negative value of CT scan for diagnosis of neoplastic lesions of lung were 97 % and 3 % respectively, in our study. Among our study population, mean age with lung tumours was 61 years, highest number of cases was seen in the age group of 51 - 60 years (35 %); Males and females affected were 27 (79.41 %), and 7 in number (20.59 %), respectively. CONCLUSIONS CT is more sensitive in the detection of neoplastic lesions of the lung and associated hilar / mediastinal adenopathy than chest roentgenography. CT has a high efficacy in detecting neoplastic lesions of lung, delineating its lobar and segmental anatomy, thereby helping surgical resection of lung. In this study, CT guided FNAC and cytological findings correlated well with CT diagnosis of primary neoplastic lesions of lung. KEYWORDS Primary Lung Tumour, Contrast Enhanced Computed Tomography (CECT), Fine Needle Aspiration and Cytology (FNAC)