bluuebunny/crossref_metadata_2025 huggingface dataset:
IJCM_90A: Knowledge about newer contraceptives among health care personnel working in primary health centres in north coastal district of Andhra Pradesh- a Cross sectional analytical study
Authors: Tanuja M. , Madhavi B. Devi , Sapuri Rukmini Devi
Published: April 2024

Background:

According to NFHS -5 the contraceptive prevalence rate has 67%. The unmet need for contraception is two-pronged: a spacing method and a permanent method. A Newer Oral contraceptive pill Chhaya is suitable for both of these purposes. Another newer injectable contraceptive available as Antara. Both are having less side effects. Government of India supplies free of cost. But its current acceptance rates are lower than expected. Health Care Personnel are the key persons to educate, promote and create awareness on contraceptive acceptance in the community especially, Eligible Couple. Hence this study was conducted to assess the knowledge of grassroot level of Health Care Personnel.

Objectives:

1. To assess the knowledge of field Health Care Personnel on Newer Contraceptives. 2. To compare the knowledge among Health Care Personnel in Urban and Rural PHCs.

Methodology:

A cross-sectional analytical study was conducted among 100 Health care personnel (5 Urban & 5 Rural PHCs) of North coastal district, Andhra Pradesh during November 2023 by simple random sampling with prevalence 50% and with allowable error 10%. Those who are willing, included in the study after taking written informed consent. Knowledge was categorized as Poor, Fair, Good. Data was collected by using pretested semi-structured questionnaire. Data was entered and analyzed using MS Excel and SPSS 21. Prior approval from institutional educational committee was obtained.

Results:

Mean age of study population is 38 ± 17 years. Mean service was 8.4 ± 9 years. 72% of study population were =10th standard.39.8% of the health care personnel have fair knowledge and 60.2% of health care personnel have poor knowledge on newer contraceptives. Fair Knowledge was more among urban study subjects.

Conclusion:

Knowledge about contraceptive was inadequate in majority of health care personnel. It should be enhanced by conducting scrupulous training programs.
IJCM_92A: Pregnancy outcomes associated with antenatal care service utilization & barriers and enablers affecting the utilization of antenatal care services in South-East Delhi: A community-based cross-sectional study
Authors: Bano Aysha , Islam Farzana , Alvi Yasir
Published: April 2024

Background:

Antenatal care provides preventive health care, through which women can learn from skilled health personnel. Women who don’t consume Iron Folic Acid Supplements as prescribed would experience iron and folic acid (IFA) deficiency anemia. Iron deficiency has negative effects on mothers and newborns while folic acid deficiency in pregnancy causes pre-eclampsia, preterm delivery, neural tube defects, fetal malformation, type 2 diabetes, and obesity in the newborn. Comprehensive antenatal care is early registration of pregnancy (within 12 weeks), at least four ANC visits at a health facility, two doses of tetanus toxoid, and at least 100 days of IFAS consumption.

Objectives:

1-To assess pregnancy outcomes associated with antenatal care service utilization in participants aged 18-49 years residing in the field practice areas of a Medical College in South-East Delhi. 2-To determine the barriers and enablers affecting the utilization of antenatal care services in the given population.

Methodology:

It is a community-based cross-sectional study conducted in South-East Delhi. The sample size was calculated as 300 considering a 5% absolute error for a 95% confidence interval and 10% non-response rate. Out of 300, the current data of 200 participants will be depicted here. Stratified systematic random sampling with the Probability Proportional to Size technique was applied to the population registered at RHTC & UHTC. Households were selected by systematic random sampling. Pregnant women aged between 18-49 years were selected from the household. A self-designed, pre-tested, validated structured questionnaire was used.

Results:

Out of the total number of participants, 66.0% had knowledge regarding early registration of pregnancy. 80.0 % had permission to attend a health facility, 70.5 % had an accompanying person, 62.5 % of participants had been residing more than 6 km away from the health facility. 58.0 % of participants could meet the expenses of health care services. Out of all newborns, 90.0 % had normal birth weights, 10% had low birth weights, 81.0% participants had NVDs, and 19% were caesarean sections.

Conclusion:

Enablers are knowledge regarding early registration, presence of accompanying person. Permission for health visits, expenses for health care services & distance to health facility were barriers.
IJCM_94A: Risk Factors for Short Birth Intervals in women: A Case-Control Study from a Tertiary Health Care facility in Central India
Authors: Shingnad Saurabh , Wadhva Sarita , Narlawar Uday
Published: April 2024

Background:

The interval between successive pregnancies, commonly referred to as the birth interval, plays a crucial role in maternal and child health outcomes. Optimal birth spacing is associated with improved maternal nutritional status, reduced risks of adverse pregnancy outcomes, and enhanced child survival. Conversely, short birth intervals, defined as intervals less than 24 months between two consecutive live births, have been linked to an increased likelihood of adverse maternal and child health consequences. Through a comprehensive examination of the contextualized risk factors, we aim to provide evidence that can guide healthcare practitioners, policymakers, and public health professionals in their efforts to improve maternal and child health outcomes in Central India.

Objective:

To determine risk factors for short birth interval among women in the tertiary health care centre of Central India.

Methodology:

A hospital-based unmatched case-control study was employed on 45 cases and 45 controls. Cases were women who gave birth within the last 6 months and with at least two consecutive alive births with a birth interval of less than 33 months. Controls were women who gave birth within the last 6 months and had a birth interval between 33 to 59 months between two successive live births. The data was collected by predesigned and pretested semi structured questionnaire from selected respondents.

Results:

Some important risk factors identified in the present study were age less than 30 years, use of contraception and shorter duration of breastfeeding.

Conclusion:

Encouraging postpartum family planning and effective breastfeeding will go a long way to reduce the prevalence of short birth interval and its consequences on maternal, neonatal and child health
Association of Attention Deficit Hyperactivity Disorder with the Use of Oral Propranolol in Infantile Haemangiomas: An Ambispective Comparative Study
Authors: Sharma Apoorva , Venkatesan Velprashanth , Sharma Akhilesh , Ashraf Raihan , De Dipankar , Handa Sanjeev , Mahajan Rahul
Published: April 2024

Previous studies have raised concerns about the effects of oral propranolol on the central nervous system in infants, the exact measure and mechanism and the long-term follow-up of which is less well studied. This was an ambispective comparative study of children with infantile haemangioma (IH) followed by a repeat visit 4–10 years after completion of propranolol therapy. Parents were asked about psychologic functioning along with an initial screening examination. All patients were evaluated by a paediatric psychiatrist. After evaluation by the Strength and Difficulties Questionnaire, and subsequently by the paediatric psychiatrist, 2 of 12 patients (16.67%) showed features of attention deficit hyperactivity disorder in comparison to 0 of 40 subjects in the control group (0.0498; α = 0.05). These results indicate an increased risk of neuropsychiatric illnesses such as attention deficit hyperactivity disorder (ADHD) in patients given propranolol for IH, as supporting evidence to previous claims.
Clinico-Laboratory Profile of Tuberculides: An Experience at a Tertiary Care Centre from Chandigarh, India
Authors: Poonia Kavita , Thami Gurvinder Pal , Dogar Kanika , Jain Surbhi
Published: April 2024

Background:

Tuberculides are characterised by delayed-type of immunologic reactions to Mycobacterium tuberculosis or its products in immuno-competent individuals. We herein describe clinico-epidemiological features and response to treatment in patients with tuberculides from a tertiary care centre from North India.

Methods:

This was a retrospective analysis of the clinical records of all the cutaneous tuberculosis (TB) patients (year 2000–2019) enrolled in the TB clinic. The patient records fulfilling the diagnostic criteria of tuberculides were considered for analysis.

Results:

A total of 225 patients attended the tuberculosis clinic; out of this, 34 were diagnosed as tuberculides. Out of these 34 cases, 21 were identified as LS, 2 erythema induratum of Bazin, 1 papulonecrotic tuberculide, and 10 erythema nodosum. History of contact to open cases of TB was present in 15/34 (44.1%) patients. History of BCG vaccination was found in 15/34 (44.1%) patients. The focus of underlying TB could be identified in 20/34 (58.8%) patients. Skin biopsy was performed in all patients. In all patients, the diagnosis was confirmed by clinico-pathological correlation, positive TST, and the underlying focus of TB. All patients received 6 months regimen of anti-tubercular therapy with first-line drugs.

Conclusion:

In this study, we demonstrated various forms of tuberculides; lichen scrofulosorum was the most common form. We also included erythema nodosum cases also, which responded well to ATT. Observation from our study showed that tuberculides are important cutaneous markers for underlying tuberculosis infection, which helps in early detection of occult tuberculosis and timely management.
Clinico-Epidemiologic Profile of Non-Syndromic Congenital Ichthyosis – A Retrospective Chart Review of 107 Patients
Authors: Mahajan Rahul , Bakshi Shirin , Chatterjee Debajyoti , De Dipankar , Saikia Uma N. , Handa Sanjeev
Published: April 2024

Background:

Congenital ichthyoses are a rare Mendelian group of disorders affecting the integument with a heterogeneous clinical presentation amongst which scaling is a constant feature. There is scanty epidemiologic data regarding the clinical profile and histologic patterns of inherited ichthyosis from resource-poor countries.

Aims and Objectives:

The study was aimed at assessing the clinic-epidemiologic characteristics associated with the different forms of non-syndromic congenital ichthyosis.

Materials and Methods:

This was a retrospective chart review of ichthyosis patients that presented between July 2016 and Jun 2020. Details including demographic profile, clinical characteristics along with any relevant investigations done were included.

Results:

During the study period of 4 years, 107 patients with congenital non-syndromic ichthyosis were seen. The most frequent diagnosis was of common ichthyoses, followed by autosomal recessive congenital ichthyosis, epidermolytic ichthyosis and erythrokeratoderma, in decreasing order.

Conclusion:

Important clinical findings like erythema and the type of scales as well as histological differences including an absent or reduced granular layer in ichthyosis vulgaris can help differentiate among the clinical phenotypes of inherited non-syndromic ichthyosis especially in resource-poor settings. Also, there is a high prevalence of vitamin D deficiency and hence a need for screening for the same in all patients of congenital ichthyosis including the milder phenotypes.
Laser and Lights in Psoriasis
Authors: Sarda Aarti , Vaidyanathan Varsha , Das Sudip , De Abhishek
Published: April 2024

Psoriasis is a chronic inflammatory skin condition affecting millions of individuals worldwide. Over the years, various treatment modalities have been explored to alleviate the symptoms and improve the quality of life for patients with psoriasis. Among these treatment options, lasers and lights have emerged as promising non-invasive approaches with significant efficacy. This review aims to provide an overview of the current understanding and clinical applications of lasers and lights in the management of psoriasis. We have discussed the mechanisms of action behind different laser and light therapies and their impact on psoriatic plaques. Additionally, we discuss the various types of lasers and lights utilized, including excimer lasers, pulsed dye lasers, and narrowband ultraviolet B (NB-UVB) phototherapy, highlighting their unique properties and clinical outcomes. Moreover, we have addressed important considerations related to patient selection, treatment protocols, and potential side effects associated with lasers and lights. We emphasize the need for proper evaluation, monitoring, and customization of treatment plans to ensure optimal outcomes and minimize adverse events.
A Cross-Sectional Study to Evaluate the Role of the Nuclear Factor Kappa B (Nf-κB) Pathway in Regulating the Cytokine Cascade and as a Potential Therapeutic Target in Leprosy
Authors: Hasanoor Reja Abu Hena , De Abhishek , Chakraborty Disha , Singh Sushil , Sarda Aarti , Das Sudip
Published: April 2024

Pattern recognition receptors (PRRs), which are found in microorganisms but not in hosts, allow Leprae bacilli to be recognized as foreign. Several kinds of pattern recognition receptors, such as toll-like receptors (TLRs), NOD-like receptors (NLRs) and RIG-1-like receptors (RLRs), are present in the innate immune system. Sen and Baltimore (1986) discovered the transcription factor nuclear factor kappa-B (NF-B), employed by eukaryotic cells to regulate immunity, cell differentiation and proliferation. This study aimed to evaluate the role of the nuclear factor kappa B (NF-B) pathway in controlling the cytokine cascade in leprosy due to a lack of understanding of the link between cytokines and the severity of leprosy. Clinically suspected Hansen’s patients were analysed for 4 years. Newly diagnosed leprosy patients were considered to have leprosy disease control (LDC). The cases with active or new lesions and an increase in BI by at least 2+, 12 months after completion of MDT were considered leprosy disease relapse (LDR) cases. Age- and sex-matched healthy individuals served as our control group (HC). An ELISA was performed to measure the concentration of five human cytokines. By qRT-PCR, the quantitative expression of receptor genes (NOD1 and NOD2), cytokine genes and the expression of the transcription factor NFκβ were evaluated. This was followed by a transcription factor NFκβ assay to see its expression in the monocytes of study subjects. Nuclear factor NF-κβ was found to have a pronounced response in monocytes of HC and LDC patients and LDR cases when treated with NOD1 and NOD2 ligands. Our study concludes that the NF-kB pathway is involved in the induction and regulation of the cytokine cascade that contributes to chronic inflammation in leprosy.
An Observational Study to Correlate the Histopathological and Dermoscopic Features in Leprosy Patients in a Tertiary Care Hospital
Authors: Sahu Aliva , Biswas Saumitra , Das Sudip , Bhattacharyya Aditi
Published: April 2024

Introduction:

Leprosy is a chronic granulomatous infection with varied clinical presentations. Dermoscopy is a noninvasive technique widely used in the diagnosis of various skin diseases.

Objective:

To see the correlation between the clinical and dermoscopic features with the histopathological findings in leprosy.

Materials and Methods:

A prospective observational study was conducted on clinically suspected leprosy patients attending the dermatology outpatient department (OPD) for 18 months. Representative lesions were observed by dermoscopy, and a biopsy was performed, followed by histopathology for final diagnosis. Patients were categorized by Ridley-Jopling classification.

Results:

A total of 70 clinically suspected leprosy patients were included in the study. Amongst 70 cases, 56 cases were diagnosed as leprosy by dermoscopy, and 53 cases were confirmed as leprosy by histopathology (hematoxylin and eosin [H and E] staining and Fite-Faraco staining). The other six cases were diagnosed as other nonspecific dermatitis by histopathological findings. Eleven cases that were dermoscopically negative were also confirmed by histopathology to be truly negative. There are three inconclusive cases of dermoscopic findings, which were diagnosed as mid-borderline leprosy by histopathology. Dermoscopic and histopathological correlation was found above 87% in all types of leprosy except mid-borderline leprosy, which showed only a 25% correlation.

Conclusion:

Dermoscopy is a useful noninvasive tool to assess lesions of leprosy, requires less time for diagnosis, skin features are magnified several times and may become evident before clinical presentation. It definitely helps to reduce the number of biopsies in case of diagnosis of leprosy. However, in doubtful cases, histopathology is required for definitive diagnosis as it is the gold standard to date.
Bilastine in Refractory Chronic Spontaneous Urticaria: Disease Control and Cytokine Modulation in an Open-label Prospective Study
Authors: De Abhishek , Singh Sushil , Chakraborty Disha , Sarda Aarti , Godse Kiran
Published: April 2024

Introduction:

The treatment options for chronic spontaneous urticaria (CSU) primarily include second generation non-sedative antihistamine (SGAHs). Bilastine is a newer, nonsedating SGAH approved for urticaria in February 2019 by the Drugs Controller General of India. Its major advantages are in terms of superior efficacy, lack of drug interactions and adverse effects, including sedation, compared to conventional SGAHs. The role of cytokines in the pathogenesis of CSU is well known. However, there is a shortage of data regarding the change in serum levels of proinflammatory cytokines following H1 antihistamines. We conducted this trial to evaluate the role of bilastine in cytokine modulation and autoimmunity, thereby explaining its role in modifying the disease process in CSU.

Materials and Methods:

This prospective study was conducted in a tertiary institute in Kolkata on patients aged 12 years and above with a CSU >6 months. These patients had an unsatisfactory response, as per the Urticaria Activity Score 7 (UAS7), to previous antihistamine therapies in standard doses. Treatment effectiveness was determined by comparing the UAS7 at baseline with that at weeks 4, 8 and 12. Also, baseline serum interleukin-6 (IL-6) and IL-17 were compared with those at the end of the study, that is, 12 weeks.

Results:

Thirty patients who matched the inclusion criteria and signed informed consent were included in the study. At the end of 12 weeks, 10% of patients (n = 3) achieved a complete treatment response (UAS = 0), whereas 43.33% of patients (n = 13) were labelled as having well-controlled urticaria (UAS <6). At 12 weeks, the mean UAS7 score (6.47 ± 4.45) was statistically significant compared to the baseline score (25.47 ± 7.74). The mean values of serum IL-6 (pg/ml) and IL-17 (pg/ml) at baseline were 5.96 ± 5.24 pg/ml and 6.96 ± 5.97 pg/ml, respectively. At the end of treatment, that is, 3 months, the mean values were reduced to 4.61 ± 4.56 pg/ml and 5.08 ± 3.87 pg/ml. The reduction was statistically significant for both serum IL-6 (P < 0.001) and IL-17 (P < 0.0001).

Conclusion:

We conclude that bilastine at a once-daily continuous dose of 40 mg for 3 months is safe and effective in CSU patients who are refractory to treatment at the standard doses of SGAHs. Improved symptomatic control with bilastine was also associated with better control over the inflammatory process, as suggested by the lowering of mean cytokine levels in our study.
Epidermal Biophysical Characteristics in Patients with Vitiligo and the Association with Thyroid Auto-immunity and Itch
Authors: Teh Yu L. , Jamil Adawiyah
Published: April 2024

Background:

Vitiligo is characterized by depigmentation due to melanocyte destruction. Itch is an under-recognized symptom; its pathophysiology is unclear.

Aims:

To compare epidermal biophysical characteristics of the vitiligous skin and normal skin and to determine the association with thyroid auto-immunity and itch.

Methods:

A cross-sectional study involving vitiligo patients was conducted. Hydration, pH, and trans-epidermal water loss (TEWL) at the vitiligous skin and normal adjacent skin were measured. The Vitiligo Disease Activity Score (VIDA) and Vitiligo Area Scoring Index (VASI) were assessed. Itch severity and thyroid auto-antibodies were determined.

Results:

Thirty-nine (62.9%) females and 23 (37.1%) males participated. Twenty-six (41.9%) had stable vitiligo, and 36 (58.1%) had active disease with a median VASI was 0.8 (2.2). Hydration was lower [93 (83) to 125.5 (111) vs 104 (73) to 156 (100), P < 0.01] and TEWL [7.13 (6.18) to 8.86 (6.93) vs 5.54 (5.90) to 6.88 (6.37), P < 0.01] was higher at the vitiligous skin compared to the normal skin. A non-significant higher pH trend was observed in the vitiligous skin. Thyroid antibody was detected in 19.7% patients. There were no significant differences in biophysical characteristics between patients with and without thyroid antibodies, with hydration of 88 (159) to 129.5 (120) vs 91.5 (81) to 116 (101) and TEWL of 7.08 (2.03) to 9.97 (6.38) vs 7.65 (7.54) to 8.22 (6.52). Itch was reported by 14 (22.6%). Patients with itch had lower hydration and higher TEWL but were not significantly different from patients without itch.

Conclusions:

The vitiligous skin has reduced hydration and increased TEWL, suggesting a defective epidermal barrier. Thyroid antibody positivity was not associated with biophysical characteristics or itch. Itch was not associated with hydration, pH, and TEWL. An impaired epidermal barrier and itch need to be addressed in vitiligo management.
Sphenopalatine Ganglion Block Using Intranasal Lignocaine Spray for Trigeminal Neuralgia: A Case Series
Authors: Dubey Preksha , Dubey Prakash K.
Published: April 2024

Various interventions have been tried for the management of trigeminal neuralgia which is a sharp, shooting recurrent neuropathic pain. The use of the sphenopalatine ganglion (SPG) block has been established as a fast, safe, and effective means of pain relief for these patients. Recently, 10% lignocaine spray has been described as a less invasive alternative for this block. We report seven patients of idiopathic trigeminal neuralgia with acute unilateral severe pain managed by SPG blocks using 10% intranasal lignocaine spray. Seven patients with unilateral trigeminal neuralgia were included in the study. Two puffs of 10% lignocaine were sprayed into the nostril of the affected side in a slightly medial and inferior direction. Before the procedure and 30 min later, Visual Analog Scale (VAS) scoring was done. The procedure was repeated in case of no pain relief after 1 h of nasal spray (VAS 4 or 5). All patients were observed for 2 h and oral medication was prescribed if required after assessment at 24 h. Four patients reported complete relief (VAS 0 or 1) and two of them reported pain (VAS 4 and 5) after 24 h. The procedure had to be repeated in two patients with no pain relief (VAS 4 and 5) after 1 h. There was no relief in one patient even after repeated administration (VAS 5). The findings suggest a role for intranasal lignocaine spray for SPG block in trigeminal neuralgia for alleviating acute exacerbations of pain and obtaining quick relief.
Enhancing Pediatric Regional Anesthesia: A Narrative Review of Adjuvants used with Local Anesthetics
Authors: Arora Prateek , Iqbal Javaid , Dey Samarjit , Balasubramanian Bhuvaneswari , Reddy Vamshidhar C
Published: April 2024

Pediatric regional anesthesia has become an integral part of perioperative pain management strategies in children. Adjuvants play a pivotal role in augmenting the efficacy and prolonging the duration of regional anesthesia techniques, thereby improving postoperative pain control, and reducing opioid consumption. This review provides a comprehensive overview of the various adjuvants utilized in pediatric regional anesthesia, highlighting their mechanisms of action, clinical applications, efficacy, and safety profiles.
Comparison between Ultrasound-guided Percutaneous Needle Tenotomy and Extracorporeal Shockwave Therapy in Reducing Pain and Functional Disability in the Management of Recalcitrant Lateral Epicondylosis: A Randomized Controlled Study
Authors: Choorapra Sreejith , Nilachandra Longjam Singh , Akoijam Joy Singh , Swami Tripti , Chabungbam Margaret , Pilania Chandrakant , Rajkumari Kanti , Janet Moirangthem
Published: April 2024

Background:

Tendinopathies like lateral epicondylosis (LE) are a difficult problem requiring lengthy management with patients often responding poorly to treatment. Although it is known as a tendonitis, histopathologic studies in recalcitrant LE have shown that it is associated with few inflammatory cells and more of fibroblasts. Emerging regenerative therapies such as autologous blood, platelet-rich plasma, extracorporeal shockwave therapy, and tenotomy have a significant role in the management of recalcitrant cases. The present study aimed to compare ultrasound-guided percutaneous needle tenotomy and extracorporeal shockwave therapy in reducing pain and functional disability in the management of recalcitrant LE.

Materials and Methods:

A randomized controlled study was conducted for 2 years on 82 patients recruited from the outpatient department, and they were randomly assigned to two groups – Group A (41 patients) received extracorporeal shockwave therapy, while Group B (41 patients) underwent ultrasound-guided tenotomy of the common extensor tendon. The outcome was measured by the Visual Analog Scale (VAS), grip strength, and Patient-Rated Tennis Elbow Evaluation (PRTEE) and was assessed at baseline, 4, 12, and 24 weeks.

Results:

At the end of 24 weeks, the VAS score was 1.34 ± 0.48 in Group B, while it was still 3.44 ± 0.59 in Group A. The PRTEE score reduced to 24 ± 1.74 in Group B compared to 40.91 ± 2.94 in Group A.

Conclusion:

Percutaneous tenotomy provides significant improvement in pain and elbow activities as measured by VAS and PRTEE at 24 weeks, and thus, a single percutaneous tenotomy may be considered as a cheap and easy novel alternative in resistant cases of LE.
Best Practices for the Evaluation and Management of Low Back Pain in Primary Care: A Multidisciplinary Expert Consensus
Authors: Srinivasan A. V. , Dureja G. P. , Banerjee Tapas Kumar , Chaudhuri Jaydip Ray , Benny Rajesh , Archik Shreedhar , Mascarenhas Amrithlal A. , Marthala Pradeep Reddy , Agarwal Amit Kumar , Shah Dhara , Rajgopal Jayesh
Published: April 2024

Purpose:

International guidelines for the management of patients with low back pain (LBP) are available, but there are no India-specific guidelines for the diagnosis and management of LBP in primary care. This article aims to provide clinical insights for the diagnosis and treatment of LBP for primary care practitioners in India.

Methods:

A 3-step modified Delphi method was used to get insights and opinions from a panel of 9 multidisciplinary specialist (neurology, orthopedics, and pain management). In rounds 1 and 2, 203 and 60 statements, respectively, were circulated to the expert panel and they were asked to respond with an “agree” or “disagree” to each statement and provide comments. At least 80% of the experts had to agree for a statement to reach a concordance. More than 80% concordance was reached for 175 and 32 statements in rounds 1 and 2, respectively. Round 3 was a direct interaction with the experts.

Results:

There was good agreement among the expert panelist in round 3 for the consensus-derived statements from the earlier two rounds of the survey. The panel agreed that diagnostic triage is important to exclude specific spinal pathology, routine imaging is not recommended unless suspecting serious pathology, specialist referral is needed for serious pathologies/no improvement in pain with treatment, and management is to be individualized depending on etiology and patient factors.

Conclusions:

Primary care physicians are the first point of contact for patients with back pain. These consensus recommendations will assist primary care physicians in India to choose an appropriate course of action for managing patients with LBP.
Predictive Value of Perfusion Index for Assessing Success of Supraclavicular Brachial Plexus Block: A Prospective Observational Study
Authors: Chatterjee Sourav , Majumdar Uma , Gupta Debjani , Sarkar Chiranjib , Chatterjee Subhadeep
Published: April 2024

Background:

Perfusion index (PI) is a simple, objective, and noninvasive method for evaluating the success of brachial plexus blocks. There is only one study which assessed the time point at which the PI had the best predictive value.

Aims:

Of the 5 measured outcome variables (i.e.; PI at baseline, at 5 min, at 10 min, and at 15 min and PI ratio), we wanted to determine the one which had the best predictive value for block success.

Materials and Methods:

It is a prospective observational study done in a tertiary care teaching hospital. Sixty-nine patients of either sex, American Society of Anesthesiologists Physical Status I and II, between the ages of 18 and 65 years posted for elective upper limb surgery were included. Patients were given supraclavicular blocks with a peripheral nerve stimulator. PI recorded at baseline, 5 min, 10 min, and 15 min. A PI ratio was calculated. Sensory and motor blocks were assessed at 5-min intervals.

Statistical Analysis:

Descriptive analysis was applied by mean and standard deviation for quantitative variables and frequency and proportion for categorical variables. Receiver operating characteristic (ROC) curves were constructed. SPSS version 22 was used to detect an area under the ROCs (AUROC) curve and calculated to assess how good a test PI at 10 and 15 min and PI ratio are in predicting the outcome of a block.

Results:

The mean PI increased continuously from the baseline till 15 min in successful blocks, but in unsuccessful blocks, the rise was not seen. ROC curves showed an AUROC curve of 0.93 in case of PI at 15 min and 0.84 for PI ratio.

Conclusion:

We conclude that PI at 15 min is the best in our study and PI ratio is the next best as a predictor for evaluating success of supraclavicular blocks.
Utility of Ultrasound-Guided Continuous Lower Limb Perineural Catheters for Treatment of Pediatric Complex Regional Pain Syndrome Type I: A Primary Case Report from India
Authors: Subhasree N. , Anuradha Ganigara , Shruthi A. H. , Sharmila Somayaji
Published: April 2024

Complex regional pain syndrome (CRPS) is a chronic localized pain condition affecting all age groups with more propensity toward adolescent girls. This disease has a multifactorial pathophysiology involving the sympathetic and central nervous system, along with psychosocial, immune, and genetic factors. We reported a case of CRPS Type I in an adolescent boy who was successfully managed by continuous lower limb nerve blocks through perineural catheters along with the continuation of pharmacological management.
Cyberknife Stereotactic Radiosurgery for Trigeminal Neuralgia: A Single-Institution Retrospective Analysis of Clinical Outcomes
Authors: Pillai Rajkumar Sangaiah
Published: April 2024

Introduction:

CyberKnife stereotactic radiosurgery (CKSRS) is recognized as a highly efficient intervention for refractory trigeminal neuralgia (TN). Our study aims to evaluate the clinical outcomes of CKSRS in treating medically refractory TN. By assessing these results, we aim to understand CKSRS efficacy and its potential as an alternative for nonresponsive patients to traditional medical treatments.

Methods:

In a retrospective study carried out at my institution, 25 patients with refractory TN were treated between 2018 and 2020. Clinical outcomes, including pain control and hypoesthesia/numbness, were assessed at 6, 12, and 24 months after CKSRS. The study employed the Barrow Neurological Institute pain intensity and facial numbness scores acquired through a telephone questionnaire to assess pain relief and the onset of facial hypoesthesia, thus establishing the effectiveness of the treatment.

Results:

There were 14 male and 11 female patients. Among all the patients, 44% experienced relief from pain and were not on any medication for pain, whereas 52% reported occasional pain that did not require medication at the end of the study period. The adverse effect of CKSRS, facial numbness, was observed in 58% of patients as mild facial numbness and in 44% as bothersome facial numbness. Moreover, a higher dose of CKSRS administered to the trigeminal nerve was associated with statistically significant pain control (P < 0.05).

Conclusion:

The study concludes that CKSRS is a safe and effective treatment option for refractory TN. It is worth noting that the occurrence or progression of facial hypoesthesia posttreatment was identified as a predictor of prolonged pain relief.
PRP and its benefit as an adjunctive therapy with subcision and microneedling in atrophic scars: a comparative study
Authors: Vashisht Aditi , Krishna Arvind , Chugh Robin , David Abhinav , Srivastava Divyanshu
Published: April 2024

Context:

Scarring is a biological process of wound repair which leads to a difference in the normal structure and function of the skin and manifests as a depressed or raised area. Treatment of scars is challenging. A number of therapeutic approaches like surgical techniques and non-surgical techniques are performed to improve scarring.

Aims and Objectives:

The aim of this study was to compare the outcome of subcision followed by microneedling versus subcision followed by microneedling and topical platelet-rich plasma (PRP) in atrophic scars.

Materials and Methods:

A comparative prospective study was conducted at a tertiary care hospital in North India to compare the efficacy of subcision followed by microneedling versus subcision followed by microneedling and topical PRP. A total of 40 cases were taken and were randomly divided into two groups, A and B of 20 patients in each group. Topical PRP was applied as an additional therapy in Group B in the same sitting. Minimum three sittings were done in each patient at an interval of 4 weeks and results were assessed after 1 month of the third session. The statistical software used is Microsoft Excel and SPSS software program, version 24.0 for analysis of data and Microsoft Word to generate graphs and tables.

Results:

Improvement in scar grading was more in Group B as compared to Group A with statistically significant difference (P = 0.032). There was an improvement in scar grading from grade 4 scar to grade 2 in 15% and 30% patients of Groups A and B, respectively, with improvement in skin texture and pigmentation more in Group B.

Conclusion:

PRP proved to add to the improvement of grade of atrophic scars when combined with subcision and microneedling.
Chrono Dentistry and the association between shift work and oral health in a representative sample population: An Internet survey
Authors: Gupta Rashi M. , Jha Suraj M. , Nimma Vijayalaxmi
Published: April 2024

Background:

Most physiological processes in mammals display circadian rhythms that are driven by the endogenous circadian clock. Disruptions of the circadian clock have been associated with nearly every major human disease. With that as the central idea, this study attempted to see the variations in the form and function of the oral cavity with respect to the circadian cycle by comparing the oral health problems of daytime-only workers with those who worked night shifts.

Aims:

To study the relationship between the circadian clock and oral diseases by comparing the oral health problems and lifestyle of daytime-only and night shift workers.

Methods and Material:

A pre-validated questionnaire containing 12 close-ended questions was circulated among 40 night and 40 day shift workers. Appropriate statistical analysis was carried out.

Results:

Increased incidence of extractions and decay was found in night shift workers. Of all, 65% of the day shift workers had lost a few of their teeth to decay and extractions while the same was found in 70% of the night shift workers. Pain in teeth was also found to be prevalent in night shift workers with 80% of the participants claiming that they experienced pain in their teeth while 60% of the day shift workers experienced such pain. 90% of the participants claimed to be non-smokers in the day shift work. In the night shift, 52.5% of participants were current smokers. Smoking was prevalent among night shift workers.

Conclusions:

The results of this study show a clear relationship between night shift work and oral health problems. Hence, stronger measures to provide oral health maintenance support for night shift workers are needed.
Malignant masquerade: Clinician dilemma revisited
Authors: Dwivedi Surjeet K. , C R. Rakesh , Gaur Amit , Mohan Raj , Ajin Anto A. K.
Published: April 2024

Mimesis is a Greek word that means to imitate, while the word masquerade means pretending to be something or someone that he/she is not. In this case series of four cases pertaining to different organ subsets, we discuss and highlight the benign medical conditions, which pretended as neoplastic both clinically and radiologically preoperatively; however, the postoperatively histopathological report yielded surprising results. Though lots of literature on a malignant masquerade is available, there is a paucity of data on case series discussing the different subset organ involvement. These unique clinical scenarios also emphasize the fact that it is incorrect to judge a book by its cover. We would like to summarize our humbling experience in the word of William Osler “medicine is the science of uncertainty and art of probability.”
Evaluation of autologous platelet rich fibrin in chronic non-healing leg ulcers
Authors: Jakkampudi Anusha , Atluri Swetha C. , Salecha Akshay J. , Haritha S
Published: April 2024

Context:

Chronic non healing leg ulcers cause psychological, social, and financial burden to the patient. Platelet rich fibrin (PRF), a biological membrane with plethora of growth factors acts as a cheaper and simpler option for the management of non-healing leg ulcers.

Aims:

To evaluate the effectiveness of PRF in the treatment of chronic nonhealing leg ulcers of varying etiologies.

Material and Methods:

It was a prospective study conducted in 30 patients in a tertiary care center. PRF dressing was done weekly for the chronic non healings ulcers of various etiologies for 6 weeks. Response to therapy was assessed by calculation of wound area and volume and digital photographs before each treatment session. Statistical analysis was done using Chi-square test, paired t-test and ANOVA test to get P values.

Results:

In our study, the mean age of subjects was 55.9 ± 14.08. 21 (70%) subjects were male and 9 (30%) were female. Majority of the ulcers were trophic ulcers due to hansen’s disease (n = 11, 36.7%), followed by diabetic ulcers (n = 9, 30%), venous ulcers (n = 6, 20%) and traumatic ulcers (n = 4, 13.3%). Percentage decrease of mean ulcer area and volume were 92.3% and 97.6%, respectively. There was significant decrease in the mean area and volume (P < 0.0001) of the ulcer from 2nd week onwards till the end of 6th week.

Conclusions:

PRF can be used as an adjuvant along with standard treatment in the management of chronic non healing ulcers to reduce the duration of healing.
Type IV dual left anterior descending artery circulation: A rare coronary artery anomaly
Authors: Baig Akif A. , Mannuva Boochibabu , Betham Rajendra , Nathani Srikanth
Published: April 2024

Dual left anterior descending artery (LAD) is a rare coronary anomaly with varied presentation. We present the case of a 63-year-old male with complaints of exertional angina whose coronary angiogram and computerized tomography coronary angiogram showed type 4 dual LAD arteries, a rare variant of dual LAD.
A study on the relation between preoperative serum albumin levels and postoperative outcome in emergency abdominal surgeries
Authors: Kiran Simhadri Uday , Tribhuneswari Marreddy , Dunga Swetha , Sanath Sai , Minhaaj Minhaaj , Naren Surapaneni Sai Venkata
Published: April 2024

Background:

Nutritional evaluation is critical for identifying patients who are at risk of developing postoperative complications as a result of severe malnutrition. One of the routinely used markers to assess nutritional status is serum albumin.

Aims and Objectives:

The aim of the study is to evaluate the relationship between preoperative serum albumin levels and postoperative outcomes in emergency abdominal surgeries.

Materials and Methods:

This prospective analytical observational study was conducted on 50 patients who underwent major emergency abdominal surgeries under the department of general surgery in Dr. PSIMS and RF from January 2021 to January 2023.

Results:

In our study majority of the cases were in the 4th and 5th decade of life. 73.33% of the patients were male and 26.66% were female. Preoperative mean serum albumin level in males was 3.22 ± 0.54 mg/dl and 3.41 ± 0.32 mg/dl in females. The rate of postoperative complication was nearly similar in both groups, that is, 14 male patients (36.36%) and 4 female patients (37.50%). The 30-day mortality rate was strongly linked (P = 0.001) to lower serum albumin levels (<3.2 gm/dl).

Conclusion:

Serum albumin is an excellent prognostic predictor due to its capacity to detect PEM, which is not always linked with reduced body weight and may not be clinically recognized, but is associated with a considerable increase in morbidity. Serum albumin level below the threshold of 3.2 g/dl was found to be a major determinant of subsequent squeal as well as mortality in the postoperative period.
Prediction of internet addiction among high school students in a rural Southern Karnataka, India—A cross-sectional study
Authors: Kumar S. J. Naresh , Ruhela Aaditya
Published: April 2024

BACKGROUND:

According to the World Health Organization, there is an explosion in the use of electronic devices, the internet, and gaming platforms. In many countries, it is a significant public health concern, prompting calls to identify adequate public policy. We aimed to investigate the prevalence of internet addiction (IA) among high school students and to assess the relationship between the internet addiction level of high school students and their demographic features with internet use.

MATERIALS AND METHODS:

A cross-sectional study was conducted among 424 high school children studying in eighth standard–tenth standard. Among 121 public and private high schools listed by the BEO (Block Education Officer) Office in Kolar Taluk four high schools were selected by lottery method from July 2021 to August 2021. The Internet Addiction Test (IAT) by Young was used to assess the intensity of internet usage.

RESULTS:

The mean IAT score of study participants was 29.6. The mean age of the study population was 14.4 ± 0.84 years. The odds of internet addiction among female students were 4.5 times higher than among male students. The majority (91.5%) of the students had used the internet for educational purpose and the other common reasons for internet usage is social media (43%), entertainment (43%), and gaming purpose (21%).

CONCLUSION:

The prevalence of IA among high school students is 14.6% with the moderate-risk population was 12.5% and the high-risk population was 2.1%. Students using the internet for both academic and non-academic purposes were more internet addicted. The real challenge is to have control over the usage of social sites—the amount of time being spent and the type of activities adolescents are doing online.
Evaluation of antenatal care utilization and its effects on obstetric and newborn outcomes at a public and private hospital of Karnataka: A comparative study
Authors: Motappa Rohith , Shetty Pratham , Acharya Srivatsa
Published: April 2024

BACKGROUND:

Neonatal outcomes and perinatal mortality are directly and significantly impacted by the use of appropriate antenatal care (ANC) during pregnancy. The objective of this study is to evaluate the association between the use of prenatal services and maternal and newborn outcomes in both public and private healthcare settings.

MATERIALS AND METHODS:

This study was carried out in two tertiary healthcare setups in Mangaluru, Karnataka: Government Lady Goschen Hospital (LGH) and Kasturba Medical College Hospital (KMCH) Attavar. Data were collected from 150 women who were a part of the study. Microsoft Excel was used to compile the data, and SPSS version 25 was used to analyze it.

RESULTS:

We found that 58 out of 90 women admitted to LGH went for ANC check-ups at least four times during their gestation period and the rest of them went eight times or more, compared to just 3 out of the 60 women admitted at KMCH who went at least four times, whereas the rest went eight or more. The number of checks the mother takes appears to affect the term of the gestation with fewer preterm seen in patients who have come for a minimum of eight ANC visits, a higher risk of abnormal weight gain during pregnancy, and a lower risk of giving birth to preterm babies.

CONCLUSION:

The study reveals that private healthcare setups offer more antenatal services, including hospital visits, routine testing, supplements, and doctor advice. The number of antenatal visits is a significant difference between public and private healthcare setups. The public setup requires a minimum of four antenatal care visits, while the updated 2016 version requires eight. The number of antenatal visits affects both mother's and neonatal outcomes. A higher number of visits leads to fewer preterm births and a higher risk of abnormal weight gain. Education also influences the frequency of antenatal visits. The study suggests increasing the frequency of prenatal care visits and improving public education on this matter.
Perception of undergraduate medical students on learning physiology: A descriptive cross-sectional study in a medical school of South India
Authors: Ashwathy VT , Avanthi E , Narayanam Harini , Lokesh BN
Published: April 2024

BACKGROUND:

Understanding the various principles in physiology is very important for medical students to apply their knowledge in clinical practice. Most of the students learn physiology just to clear exams. There is a need to understand the student’s perception on the significance of learning physiology in medical colleges, its role in clinical practice, research, and the subject of career choice.

MATERIALS AND METHODS:

A descriptive cross-sectional questionnaire-based study was conducted in a medical college in Karnataka, India. A total of 100 medical students studying in year 2 MBBS were enrolled into the study. Responses were collected, validated, and analyzed to understand the perception.

RESULTS:

All the participants (100%) felt physiology is an important subject in the medical curriculum and 93% of participants felt physiology knowledge was essential to become a better doctor. It was observed that 48% of the participants were interested in pursuing research in physiology and only 24% of the participants agreed on considering physiology as a carrier option.

CONCLUSIONS:

Medical students perceived physiology as an important and interesting subject in the medical curriculum. However, only few of the students were inclined to do research in physiology and agreed on pursuing physiology as a carrier option. The scope of study in physiology is vast due to the large variety of interdisciplinary topics included in different systems. Subsequent decrease in job opportunity, lack of awareness of research opportunities, and lower pay scale in the medical colleges in India lead to less interest in students for considering physiology as a carrier option.