bluuebunny/crossref_metadata_2025 huggingface dataset:
In Acute Appendicitis, Neutrophil/Lymphocyte Rate and C-Reactive Protein’s Radiological Relation with Appendix Diameter and İnvestigation of İts İmpact on The Diagnosis
Authors: Ethem Bilgic  , Ozden Yıldırım Akan
Published: April 2024

Acute appendicitis is one of the most common causes of acute abdomen in general surgery clinic. Delayed intervention results inperforation and because of the delay morbidity and mortality increase. In general surgery clinics, common tendency is carrying out a surgery on the patients before symptoms become fully manifested. Today, there is a marked decrease in mortality related to acute appandicitis thanks to increase on diagnosis methods and advances in screening technology but there is no decrease in negative laparotomy. In our study, we investigated the radiological relation of NLO, CRP, leucocyte values in the patientsdiagnosed with acute appendicitis with appendix diameter and the contribution of their co-use on the diagnosis.
THE EFFECT OF ANESTHESIA ON VAGINAL DELIVERY
Authors: Zinah Zuhair Abdul Razzaq  , Luay Talib Abdulmunem  , Hmed Jihad Abdulrahman
Published: April 2024

120 samples were collected at Al-Karkh, Abu Ghraib General Hospital, Baghdad, Iraq.and age was between 28-32 , The goal was to learn anesthesia for vaginal delivery Cesarean conveyances are expanding, and related postoperative unfavorable occasions are broadening hospitalizations. The points of the current investigation were to examine the job of anesthestic indicators during cesarean conveyance on the frequencies of expanded post pregnancy clinic length of stay (>4 postoperative days) and antagonistic occasions. And the clinical records of 120 back to back patients who went through cesarean conveyance during a 1-year time span were preoccupied. Recently detailed sedative indicators went through recursive dividing with 5-overlap cross-approval and with LogWorth esteems ≥2.0 and Both uterine compressions and the exit of the baby from the vagina cause labor torment that shifts between female, while 20% of female don't feel any torment, 30% of them consider that agony is conceivable and half discover the torment intense and hence it is important to turn to sedation of various examples, some of them lose the mother The inclination is completely felt, while others mitigate the sensation of torment without the shortfall of theissues.
Usage of Therapeutic Offloading In Diabetic Foot- A Clinical Audit
Authors: Amit Kumar C Jain  , Apoorva HC
Published: April 2024

Aim- To assess the usage of therapeutic offloading in diabetic foot patients in an expert diabetic foot centre and distribute them according to Amit Jain’s classification for offloading. Methods and materials- A retrospective audit was conducted at Amit Jain’s diabetic foot offloading clinic which is now an eponymous wing under Amit Jain’s Institute of Diabetic Foot and Wound Care, Brindhavvan Areion Hospital, Bengaluru, Karnataka, India. The audit was over one year period from July 2019 to June 2020. Results – There were 34 patients in whom offloading was used during this period. Majority was males (58.82%). 88.24% of patients had diabetic foot ulcer for which offloading was used. Majority of the patients (82.35%) received simple off loadings and Amit Jain’s offloading system was the commonest offloading method used at our centre. Only 5.88% of patients had total contact cast. Conclusion- Offloading is an important strategy in treatment of diabetic foot. Audit from our expert diabetic foot centre, which has dedicated offloading clinic, shows that majority of patients receive simple offloading which is easy to apply and well accepted by the patients and complicated offloading are only occasionally required.
Unusual Cause for Post Pregnancy Abdominal Bulge: A Large Desmoid Tumor
Authors: Kusum Meena  , Manchikanti Dinesh  , M M Ramshankar
Published: April 2024

Desmoid tumors are rare tumors which have shown a recent change in treatment from surgical option to more conservative modalities including use of noval molecular targeted therapy in form of receptor kinase inhibitors .More understanding towards tumor biology and behaviour brought the concept of individualized treatment for this rare tumor. Abdominal wall desmoid tumors have predilection for female patients of reproductive age group and watchful waiting can be judiciously used as therapeutic option in a large number of cases after more familiarity with tumor biology.
Benign tumors of Eyelid: A 10 years’ experience from Nepal
Authors: Ben Limbu  , Suresh Rasaily  , Rohit Saiju
Published: April 2024

Aim: The aim was to describe the epidemiology of primary benign eyelid tumors over a 10-year period at one of the tertiary eye care centers in Nepal. Method: This is a retrospective, a hospital-based study in which we reviewed the medical records of all patients with histologically confirmed benign eyelid tumors who were operated on at our institute over a period of 10 years from January 2006 to December 2016. Data were collected based on age, gender, location of the lesion, clinical and histological diagnosis, types of surgery, and recurrence. A total of 477 patients with histopathology reports were included in the study and benign eyelid tumors were categorized as epidermal, Adnexal, and Stromal. Data analysis was done using SPSS 16.0. The study was conducted after ethical approval from Institutional Review Committee, and adhered to the tenets of the Declaration of Helsinki. Results: Out of a total of 477, 214 (44.9%) patients were male and 263 (55.1%) were female. The mean age of presentation was 35.36± 19.6 (range 1-93) years. The most common complaint was eyelid mass (91.2%) and the mean duration of presentation and follow-up was 43.46 ±78.55 and 15.88± 13.87 months respectively. The lower lid 206 (43.2%) was the most common site for tumor and local excision with direct closure was commonly performed procedure 291(61%). Overall, the most common histopathological diagnosis was Nevus 108 (22.6%) followed by Squamous Papilloma 58 (12.1%), epidermal cyst 52 (10.9%), capillary hemangioma 37(7.7%), and sebaceous cyst 36 (7.5%). We found clinical diagnosis matched with a histopathological report in 326 (68.3%) patients. However,18 patients (3.77%) clinically judged as malignant were confirmed to be benign on the histopathological report. Recurrence of eyelid tumor was seen among 7 (1.5%) and out of which capillary hemangioma reoccurred in 2 (28.6%). Conclusions: The majority of our patients presented with eyelid mass frequently located in the lower lid and diagnosed as nevi on the histopathological report. However, clinical misdiagnosis was found in 31.7% of cases where clinically suspected malignant tumors 3.77% turned to be benign on histopathology. We recommend routine histopathological evaluation of all the surgically excised eyelid tumors and also aware patients of the possibility of recurrence of benign eyelidtumors.
Ovarian Pathologies in Paediatric Age Group - Our Experience and Review of Literature
Authors: Dr. Jyotsna Kulkarni  , Dr. Mandar Vaidya  , Dr. Anita Gangurde  , Dr. Satish Kapadnis  , Dr. Rajendra Chaudhari
Published: April 2024

Ovarian pathologies presenting as Adnexal Masses are rare in paediatric age group. We present retrospective, multicentric study of 20 cases, managed between Aug 2015 to Aug 2020. Patients’ age at the time of presentation ranged from 1 day to 12 years of age, 75% patients falling between 5 to 12 years. 50% patients had Simple follicular cysts, 30% had Dermoid cysts. Ovarian Torsion, Malignancy and Para ovarian cysts comprised the rest of the pathologies. As many as 70% patients presented with acute abdomen due to torsion and the remaining 30% came in elective settings. All patients with acute abdomen underwent emergency laparotomy. Laparoscopy could be offered only to those patients who came in elective settings.Incidence of ovarian pathologies presenting as adnexal masses or with acute abdomen due to compromised blood supply is on the rise. Therefore, adnexal pathologies should be considered in Differential Diagnosis of acute abdomen in paediatric patients. Aggressive surgical intervention at presentation prevents loss of ovary. Extra efforts from the treating physician are required to emphasise the need for long term follow up.
A comparative study of postoperative chronic pain after tension free inguinal hernia repair using absorbable versus non-absorbable sutures for mesh fixation
Authors: Dr. Sunny  , Dr Ashish Luthra  , Dr Vikramaditya  , Dr. Amit Mittal  , Dr. Sahil Data
Published: April 2024

Background: Inguinal hernias are very commonly encountered by surgeons throughout the world. Chronic groin pain may be caused by nerve injury either during dissection or retraction, or nerve entrapment due to post-operative fibrosis, or mesh related fibrosis, or lastly sutures used to fix the mesh. The mesh can be secured by non-absorbable sutures or absorbable sutures. Material and methods: This is a prospective, descriptive, single centre and randomized study was conducted in the Department of General Surgery, N.C Medical College and Hospital over a period of 1 year. All patients of 21-80 years old, who were admitted for elective inguinal hernia repair, were included for the study. Patients with bilateral, recurrent, irreducible or incarcerated hernia and patients with co morbid conditions that might interfere with pain assessment (e.g. impaired cognitive function, limited mobility, daily use of pain medicine); and patients who had undergone surgery in the groin area were excluded from the study. Results: Out of 180 patients 90 were having right inguinal hernia, 56 patients with left inguinal hernia and 34 patients were having bilateral inguinal hernia. we analyzed post- operative pain using VAS score on alternate basis till 10th post-operative day. In Group A, mesh fixation was done by non-absorbable suture material polypropylene (n=90) and Group B, mesh fixation was done by monofilament absorbable suture material poliglecaprone (n=90). On post-operative day 1 the mean VAS score in group A was 6.12±1.03, while that in group B was 5.01±0.93, on day 10, the mean VAS score in group A was 2.41±0.56, while that in group B was 1.62±0.46, with a p value of 0.039 which is statistically significant. Overall, Group B experienced less pain compared to group A. Mean VAS score at 1st month in group A was 1.93±0.62 and in group B was 1.52±0.34 and at 2nd month it was 1.31±0.54 in group A and 1.03±0.26 in group B. Conclusion: Patients with absorbable suture for mesh fixation has less groin pain as compared to nonabsorbable suture in hernia repair during 6 months follow up period.
To evaluate safety and efficacy of Sitagliptin versus Metformin alone and combination in Type 2 Diabetes mellitus
Authors: Dr Rakesh Boppana  , Dr. Raghu MS  , Dr Haritha Galla
Published: April 2024

Introduction: Type 2 Diabetes mellitus is characterized characterized by insulin resistance, where the body does not fully respond to insulin. Because insulin cannot work properly, blood glucose levels keep rising, releasing more insulin. Material and Methods: This is a Comparative, Prospective, Parallel group, Randomized study. Study was conducted in Type 2DM patients attending at Department of Endocrinology, Sapthagiri Institute of Medical Scinences and Research center over a period of six months. Group I received Metformin 500 mg BD for 3 months, Group II received Sitagliptin 50 mg BD for 3 months and Group III Metformin 500 mg BD and Sitagliptin 50mg BD for 3 months. Result: The mean fasting blood glucose level in Group I at baseline was 148.75±9.54 mg/dl, in Group II was 149.85±8.38 mg/dl and in Group III was 148.47±9.58. The mean fasting blood glucose level in Group I after 3 months was 97.65±7.86 mg/dl, in Group II was 90.65±7.76 mg/dl and in Group III was 83.65±7.75 mg/dl. These was statistically highly significant difference in mean Fasting Blood Glucose level at baseline versus after 3 months in Group I, Group II and Group III (p<0.0001). The mean of HbA1c level was 7.58±0.85% at baseline and 6.94±0.74% after 3rd month. In Group II the mean of HbA1c level was 7.56±0.74 % at baseline, 6.56±0.67 % after 3rd month. In Group III the mean of HbA1c level was 7.59±0.74 % at baseline and 6.38±0.67 % after 3rd month. Conclusion: Sitagliptin with Metformin causes efficient glycaemic control with less significant adverse reaction but the gylcaemic control of patients taking Sitagliptin with Metformin was slightly better as compared to patients taking alone. Thus, concluding Sitagliptin with Metformin to be more efficacious than alone.
Impact of yoga practice on Cardiovascular Variables in Hypertensive Patients
Authors: Gottimukkala Geethavani  , Dr. Manila Jain
Published: April 2024

Introduction: The practice of yoga dates back over 2000 years to ancient India, with a focus on the unification of the mind, body, and spirit through the practice of physical movements, meditation and breathing exercises. The practice of yoga is a custom in India and has been reported to be beneficial for the patients with hypertension (HTN). Materials and Methods: This is a prospective, descriptive and observational study. Department of Physiology, Index Medical College, Hospital and Research center Indore. Period of study is from January 2020 to December 2021. Seventy hypertensive subjects on yoga therapy and Seventy hypertensive subjects on without yoga therapy was enrolled in this study. Both groups were advised to continue their regular medicines. Their Blood Pressure recorded at their first visit and thereafter before and after the yoga session after 1 week. Result: A total of 70 patients who fulfilled the selection criteria during the study were enrolled. Yoga group Mean Systolic Blood Pressureof pre-test 136.79 ± 6.76 mmHg (Mean±SD) is reduced to Post-test 129.65 ± 6.65mm of Hg (Mean±SD). In control group Mean Systolic Blood Pressure in pre-test 117.35 ± 5.67 mm of Hg and post-test 133.65 ± 6.12. However, the difference in Systolic Blood Pressure in Yoga Group is statistically significant. (P value < 0.05). Conclusion: The results imply that simple yoga exercises may beuseful as a supplementary BP therapy in addition to medical treatment when prescribed by primary care physicians. It is well known that physical activity has a BP lowering effect. A short Yoga program for patient to practice at home seems to have an antihypertensive effect, as well as a positive effect on self-rated quality of life and reduction of stress.
Evaluation of Respiratory Parameters between Normal Sedentary Male Control and Sportsman Persons
Authors: Bhausaheb Vasantrao Jagdale  , Dr. Manila Jain
Published: April 2024

Introduction: Spirometry is the most basic and frequently performed pulmonary function test. Pulmonary function testing measures how well you are breathing. There are different types of breathing tests that can be done during pulmonary function testing. These tests include spirometry, Peak flow meter, lung volumes and diffusing capacity. Lung volumes measure different parts of the breath to determine how much air you can breathe in and out. Some of the volumes are: total lung capacity, vital capacity and functional residual capacity. Material and Methods: This is a prospective, cross sectional, observational and comparative study. A total of 180 subjects were included in these studies who was divided into two groups. Group A consisted of 90 sportsman and Group B consisted of 90 normal healthy individuals. Standard spirometry was performed using the same instrument for all the subjects. Subjects underwent the test in a sitting position, wearing a nose clip. After a maximal inhalation, they sealed their lips around the mouthpiece and exhaled as hard and fast as possible. They were encouraged to continue exhaling for at least 6 seconds so that forced expiratory volume for 1 s (FEV1) and Forced Vital Capacity (FVC) could be measured. Results: TV in group A was 0.62±0.11 and in Group B 0.43±0.10. SVC of Group A 3.93±0.38 and Group B 3.22±0.23. There was statistical Significance (p<0.05) between two groups. The values expose that the TV and SVC values of tennis player were much better when compared to Sedentary subjects. FEV1 in group A was 3.59±0.41 and in Group B 2.21±0.34. FVC of Group A: 3.98±0.56 and Group B: 2.54±0.38. There was statistical Significant between two groups. Conclusion: Final analysis of the study showed that difference is present between the FEV1 and FVC values of tennis players who have long-term and regular exercises and sedentary individuals. However, there is a significant difference among MVV, FVC, and VC value between the two groups.
Effect of yoga practice on Cognition in Hypertensive Patients
Authors: Dr. Manila Jain  , Gottimukkala Geethavani
Published: April 2024

Background: Yoga is one such alternative healthcare practice thought to improve blood pressure control. There is no single definition of the practice of yoga, that is universally accepted although it is generally described as an ancient tradition (originating 5,000 to 8,000 years ago) that incorporates postures, breath control, and meditation, as well as specific ethical practices. Materials and Methods: This is a prospective, descriptive and observational study. Department of Physiology, Index Medical College, Hospital and Research center Indore. Period of study is from January 2020 to December 2021. Seventy hypertensive subjects on yoga therapy and Seventy hypertensive subjects on without yoga therapy was enrolled in this study. Both groups were advised to continue their regular medicines. Result: A total of 70 patients who fulfilled the selection criteria during the study were enrolled. Pre-test Yoga Group Mean LNS increased from 8.04±0.74 (Mean±SD) to Post-test 10.14±0.66. In control group Mean LNS in pre-test 8.54±0.58 and post-test 8.67±0.36. However, the difference in Mean LNS in Yoga Group is statistically significant. (P value < 0.05). Conclusion: A Short Yoga program for patient to practice at home seems to have a positive effect on self-rated quality of life and reduction of stress. It also lowered the patient perception on stress and it enhanced the patient perception on health.
Study on Molecular Characterization of Diarrheagenic Escherichia coli among Pediatric Patient
Authors: Mohammed Inayath Khan  , Dr. Rohit Kumar
Published: April 2024

Background: Diarrheal diseases are major cause of morbidity and mortality in low‐ to middle‐income countries and estimated to be second leading cause of mortality among children < 5 years of age, resulting in 0.5 million deaths globally. Sub‐Saharan and South East Asian regions account for highest burden of the disease (>72%). Escherichia coli is enormously versatile bacterium which elaborates its commensal and pathogenic potential in human host. Diarrheagenic E. coli (DEC) is reported as one of the leading causes of gastrointestinal disorders worldwide and signified as an important issue to address in public health. Material and Methods: This is a prospective and Cross-sectional study was undertaken among all children diagnosed with diarrhea from both admitted as well as outpatient Index Medical College, Indore. Over a period of 2 years, stool specimen of all patients reporting to the hospital with diarrhea was collected. The present study includes all subjects (children under the age of 5 years) suffering from diarrhea who report to the hospital, both admitted as well as outpatient. Stool samples from each patient, including watery stool (within 24 hours), mucous, purulent blood stool, where the patients had not taken antibiotics was considered. Results: The most of the children were belongs to 4-5 years (50.8%) followed by 3-4 years (32.5%), 2-3 years (14.1 years) and 1-2 years (2.5%). Distribution of male according to different Diarrheagenic strains of EAEC 3, ETEC 13, EPEC 9 and female EAEC 6, ETEC 7, EHEC 1, EPEC 4. Distribution of age according to different Diarrheagenic strains of EAEC of 2-3 years were 2, ETEC 9, EPEC 4 and 4-5 years EAEC 2, ETEC 3, EHEC 1, EPEC 3. Conclusion: Although in our study, proportions of DEC as diarrheal pathogen are limited to a moderate level; however, current study revealed high levels of resistance among DEC pathotypes in hospitalized patients. The observed high resistance rates to antibiotics may be a result of extreme disease severity andpersistence of infections among hospitalized patients.
Undernutrition as a Predictor of Post- Operative Morbidity, An Institutional Study
Authors: Dr. Jason Andrade  , Dr. Leo F Tauro  , Dr. Reshmina Chandni Clara Dsouza  , Dr.Shubha N Rao
Published: April 2024

Background and objective: In view of all the above , we at a tertiary care teaching hospital decided to evaluate the role of Body Mass Index as predictors of postoperative morbidity and mortality both in elective and emergency major surgeries. Materials and Methods: Descriptive Analytical Observational Study was conducted on164 patients chosen by Convenience sampling. Who had undergone laparotomy at the Father Medical College Hospital, , Mangalore who were admitted in any of the surgical departments during the period of October 2018 to October 2020 Details of cases were recorded including demography co-morbidities , blood transfusion post-operative complication ,mortality and BMI status. Data tabulation and statistical analysis to be employed: All data was analyzed using Statistical Package for the Social Sciences (SPSS) for Windows, Version 23.0. Continuous variables were expressed as mean±SD.Percentages were used to express categorical variables. Results And Analysis: In the present study the most common age was 31-40 years with 40 cases ,24.39% followed by 41-50 years with 36 cases ,21.95%, 51-60 years with 32 cases ,19.51% , and 61-70 years with 20 cases ,12.20%, More than 70 years with 16 cases ,9.76% , and less than 20 years with 4 cases ,2.44%. The mean age was 43.06 years with SD 8.04 years. We had 62 cases, 37.80% were females and 102 cases ,62.20% were males. Co Morbidities were in 82.93%, the most common was Diabetes Mellitus in 68 cases, 41.46%, Hypertension in cases, 15.85% , COPD in 12 cases ,14.63% , IHD in 9 cases ,10.98%.
An Evaluation of The Various Modalities Used for Treatment of Low Fistulas and Their Outcome at a Tertiary Care Center
Authors: Dr. Manjunath Savanth  , Dr. Clement R S Dsouza  , Dr. Reshmina Chandni Clara Dsouza  , Dr.Shubha N Rao
Published: April 2024

A fistula-in-ano is an abnormal hollow tract or cavity that is lined with granulation tissue and that connects a primary opening inside the anal canal to a secondary opening in the perianal skin; secondary tracts may be multiple and can extend from the same primary opening. Anal fistula is a common peri-anal surgical problem with which the patient presents the clinician. The study was done at in the department of General Surgery in father muller Medical College Hospital during the period from October 2018 - October 2020. Data was collected from the operated cases of all types of peri-anal fistula above 18 years and below 60 whose follow up was done for at least 6 months. In the study of 50 cases were randomly selected patients of fistula in ano, 84% of them had only one external opening, while 10% had 2 external opening and another 6% had more than 2 openings, hence fistula in ano with a single external opening is commonest in occurrence.
A Study of Management of Fistula in Ano at a Tertiary Health Care Centre
Authors: DR Amrutha M  , DR Rajeshwara.K.V
Published: April 2024

A Fistula is an abnormal communication between any two epithelial-lined surfaces. Fistula in Ano is an abnormal communicationbetween the anal canal and the perineal skin. Fistula in ano denotes the chronic phase of anorectal sepsis and is characterized by chronic purulent drainage or cyclical pain associated with abscess reaccumulation followed by intermittent spontaneous decompression. Present study was a prospective study in Department of Surgery, Fathermuller medical college and hospital. The source of data for our study was 60 patients who presented with their complaints to the surgery OPD. 60 cases of Fistula in Ano were selected and randomly divided in for the three surgical modalities equally (20 patients in each group). Group A was Fistulectomy Group. Group B was Fistulotomy Group and Group C was Seton Application group.
Fine Needle Aspiration Cytology of Lymphnodes: A Hospital Based study in a Tertiary Health Care Center in Southern Odisha
Authors: Dr Kalyani Hazra  , Dr Pranati Pradhan  , Dr Subrat Burma
Published: April 2024

Introduction: FNAC is widely accepted the most accurate sensitive, specific, cost-effective minimally invasive OPD technique to establish the basic diagnostic information not only to relieve the anxiety of the patients but also to provide materials for microbial culture, and decrease unnecessary surgery from the visibly accessible superficial masses. It also distinguishes a benign from a malignant entity that can obtain tissue for immuno-phenotyping & molecular studies and obtain cellular & genetic material for storage also useful for staging and follow up including response to treatment in patients with known malignancies. Material & methods: FNAC was performed under aseptic precaution using a 22 to 24Gauge needle attached to a 20CC disposable syringe. The aspirated material after smearing was treated with 95% ethyl alcohol for fixation & stained with H& E and Papanicolaou stain & air-dried smears are stained with Leishman stain. Modified Z-N stain was done wherever necessary followed by diagnosis based on clinic cytomorphological features. Result: Out of 796 cases the most common cause of lymphadenopathy in our study was found to be Tubercular lymphadenitis with 360 (45.22%) cases, the second most frequent entity was reactive lymphadenitis in 277(34.79%) cases followed by metastatic lesions in 47 (5.90%) cases and lymphoma 17 (2.13%) cases. Conclusion: FNAC is a simple, safe, reliable, and inexpensive method for early detection of various non-neoplastic (lymphadenitis) & neoplastic lesions (lymphoma & metastatic carcinoma) of enlarged lymph nodes which helped diagnose approximately 99% of cases.
Effect of Laser Bio stimulation and Bone Graft in Treatment of a Large Periapical Lesion – A CBCT Analysis
Authors: Dr Rehbar Khan  , Dr Mohsin Ali  , Dr Devendra Kumar Singh
Published: April 2024

India accounts for 23% of global TB burden. Of these 38% are of Extra Pulmonary Tuberculosis. Lymph node TB is the most common EPTB, pleural effusion is second most common type of EPTB in India. The bacteriological confirmation to diagnose EPTB is more difficult due to its paucibacillary nature. This study aims assessing the comparison of ADA with Gene- Xpert MTB RIF in pleural fluid in the diagnosis of tubercular pleural effusion. Study was a cross-sectional study carried out at the Department of Respiratory Medicine and Department of Internal Medicine, Muzaffarnagar Medical College, and School of Medical Science and Research, Greater Noida, Gautam Budh Nagar, UP from January 2018 to March 2019. Paired and unpaired Student's t-test, Chi square test, P < 0.05 was considered statistically significant; SPSS 18.0 software was used for analysis. The detection of MTB and rifampicin resistance using the Gene-Xpert MTB/RIF with pleural fluid ADA assay was assessed in 66 specimens. With ADA cut off as 40IU/L, 60 cases had an ADA > 40IU/L and 6 cases had ADA < 40IU/L. Pleural fluid Gene-Xpert detected MTb in 22 samples while in 44 samples MTB not detected. All pleural fluid MTb detected by Gene-Xpert were rifampicin sensitive. Gene-Xpert detected 2 tubercular pleural effusion in which ADA level was less than 40. Study shows that there was no statistically significance in diagnostic value between Gene- Xpert and ADA pleural fluid however Gene-Xpert MTB/RIF is useful method for rapid detection of MTB and Rifampicin resistance simultaneously. Estimation of ADA in pleural fluid is rapid inexpensive laboratory investigation where the diagnosis is uncertain. We found no significant connection between CBNAAT positivity and ADA level. In developing country lymphocyte predominant effusions with high ADA levels (> 40 U/L) is better option but definitely combined use of ADA and Gene-Xpert is better than using individually for the diagnosis of Tubercular pleural effusion
Prevalence of peripheral arterial disease in type 2 diabetes mellitus patients by ankle brachial pressure index
Authors: Dr. Jason Andrade  , Dr. Leo F Tauro  , Dr. Reshmina Chandni Clara Dsouza
Published: April 2024

Introduction: Diabetes is growing at an exponential rate all around the world and soon is to be an epidemic in many countries including India. India topped the list of maximum reported cases of diabetes in year 2000 with 31.7 million (reported cases) it was followed by China (20.8 million) and the United States (17.7 million) in second and third place respectively. Material and methods: A Cross Sectional Study was done in the department of General Medicine at Muzaffarnagar Nagar Medical college, Muzaffarnagar, UP from September 2021 to August 2022. All type 2 diabetic patients attending the department were invited to participate in the study those fulfilling the inclusion criteria and giving consent for inclusion in the study during the period of study were enrolled in the study. A total of 200 such patients were recruited in the study. Measurement of ABPI was made in supine position after 10 minutes of rest and in a quiet room. Results: Out of 200 patients of type 2 diabetes mellitus, 72 (36.0%) were suffering from peripheral arterial disease. Prevalence of peripheral arterial disease in patients of type 2 diabetes mellitus in our institution (a teaching hospital) was 36.0%. Mean Fasting blood sugar levels of diabetic patients with PAD (187.90+100.64 mg/dl) was found to be higher than that of without PAD (182.15+74.29 mg/dl). Mean Post-prandial blood sugar (PPBS) levels of diabetic patients with PAD (280.58+121.11 mg/dl) were also found to be higher than that of without PAD (253.22+85.30 mg/dl). Conclusion: The findings of present study thus suggested that diabetic population is at a substantial risk of peripheral arterial disease and was significantly dependent on duration of diabetes, obesity (waist circumference) and presence of other comorbidities and complications likehypertension, retinopathy and neuropathy.
Outcome of cardiorespiratory arrest in patients with respiratory diseases in emergency department: A prospective observational study
Authors: Dr. Mohammed Ahmed Yousuf  , Dr. B.N Sai Pooja
Published: April 2024

Introduction: Cardiopulmonary arrest (CPA) is the cessation of effective ventilation and circulation. It is also known as cardiac arrest or circulatory arrest. In adults, it is most likely to be caused by a primary cardiac event. The most common electrical mechanism which is responsible for 50 to 80% of cardiopulmonary arrest is ventricular fibrillation (VF). The cardiopulmonary arrest could be reversed by two main interventions, i.e., early CPR and early automated external defibrillation (AED). Objective: To study the rate of survival to discharge after in-hospital cardiac arrest and its associated factors in an emergency department of a tertiary care hospital. Materials and Methods: This is a prospective and observational study was conducted in the Tertiary Care Teaching Hospital over a period of 1 year. It is a 700-bedded tertiary care referral hospital, located in Hyderabad, India, with an average of 100 emergency cases per day. Patients elder than 12 years, who have sustained cardiac arrest after reaching the ED but before being admitted into the specialty wards were included. Who suffered witnessed cardiac arrest, after arrival in the emergency department. A semi-structured questionnaire was used to collect data. Results: Of 60 patients, 15 (25%) were discharged fully conscious, whereas 45 (75%) patients died. Age, sex, comorbidities, and cause of arrest did not show any statistically significant association with the outcome (P>0.05 for all). The duration of CPR was significantly lower in survivors (3.80 ±1.90 min) compared with non survivors (10.31 ± 6.41 min) (P<0.001). GCS was significantly higher in survivors group compared with non-survival groups (11.38±0.3 vs 3.68±1.20, P<0.001). Conclusion: These results suggest that out-of-hospital cardiac arrest among patients has a very poor prognosis, especially when efforts at resuscitation continue for longer than 20 minutes and require more than two doses of epinephrine.
A Comparison of General anesthesia and segmental thoracic Spinal Anesthesia regarding hemodynamic and respiratory stability for laparoscopic cholecystectomy
Authors: Dr Haseeb Ul Haq  , Dr Raghunath S.V.  , Dr Sushma.V
Published: April 2024

Background: Laparoscopic Cholecystectomy (LC) is conventionally performed under general anaesthesia (GA), but multiple studies have found spinal anaesthesia (SA) as a safe alternative. GA may be associated with postoperative pain and nausea and vomiting (PONV) and the use of neuraxial techniques for a variety of surgical procedures resulted in a decrease in mortality, venous thromboembolism, myocardial infarction, and several other complications. Spinal anesthesia (SA) is a commonly used anaesthesia technique that has a very good safety profile. Methods: This is a prospective study conducted in the Department of Anesthesia at Goa Medical College, Goa from June 2021 to May 2022. Ninety patients classified according to the American Society of Anesthesiology (ASA) as class I or II undergoing laparoscopic cholecystectomy, divided into two groups, 45 patients each. Written informed consent was taken from each patient before the study. Group A received conventional general anesthesia with endotracheal intubation and mechanical ventilation, and Group B received a segmental T10- T11 interspace thoracic spinal anesthesia using 1 ml of plain bupivacaine 0.5% (5 mg) in addition to 25 mcg fentanyl. In group B, drugs to manage patient anxiety or hemodynamic perturbations (bradycardia or hypotension) were given when needed. Result: Group B, receiving segmental thoracic spinal anesthesia, was more hemodynamically stable as compared to Group A. All three hemodynamic parameters pulse rate, systolic blood pressure, and diastolic blood pressure were elevated throughout the procedure in the GA group. Bradycardia was seen in 2 and hypotension in 5 cases in the Group B group. The surgeons did not find any significant difference in the operating conditions or muscle relaxation between the two groups. Patients in both groups maintained above 97-98% SPO2. Conclusion: Segmental Thoracic Spinal anesthesia is adequate and safe for laparoscopic cholecystectomy in otherwise healthy patients and offers better postoperative pain control than general anesthesia without limiting the recovery.
Clinicopathological Profiles of Anemia in Children of 6 Months to 17 Years Age
Authors: Dr. Kadukuntla Swapna Reddy  , Dr. Naila Mazher  , Dr. Hepsiba Katun  , Dr. Saadhana KMBV
Published: April 2024

Introduction: Anaemia is defined as a decreased concentration of hemoglobin and RBC mass as compared to the values in age-matched controls. Anaemia in children is one of the major social health problems in India and in many parts of the world, since anemic children have reduced exercise capacity, slower rate of growth, impaired cognitive development, and delayed wound healing. The aim of this study was to find the prevalence of anemia in different age group, sex, and its pattern of severity in hospitalized children. Materials and Methods: This are a Retrospective Study conducted in the Department of Pediatrics, Apollo Institute of Medical Sciences and Research among Children with Anemia and those Admitted with other Complaints but Incidentally have Found to have Anemia. During physical examination following signs and symptoms were noted: Pallor, edema, clubbing, skin (dryness, rashes, irritation), abnormal pigmentation, coarse hair, puffiness of face, thinning of eyebrows, nail defects, ulceration, abnormalities in genitalia, hand and feet abnormalities, nose, eyes, cranium, ear and face. Grading of anemia among different age groups was done using WHO Hemoglobin concentrations for the diagnosis of anemia and assessment of severity criteria. Microscopic evaluation of blood was also done to obtain the microscopic picture. Result: In our study, According to WHO criteria for diagnosis and assessment of severity of anemia, a total of 90 children were graded as having mild anemia 40 (44.4%), followed by 35 (38.9%) were graded as having severe anemia and remaining moderate anemia 15 (16.7%). Microcytic hypochromic picture in 56%, Normocytic hypochromic anaemia 18.8%, normocytic normochromic in 12.2%, Dimorphic anaemia 7.7% and macrocytic in 4.4% cases. Conclusion: Paediatric anaemias are very common since children are the most vulnerable population for occurrence of these anaemias. This necessitates prompt screening and early diagnosis through investigations byutilization of available advanced technical modalities in order to initiate timely treatment and appropriate management.
A Study on Sputum Induction in the Diagnosis of Smear Negative or Sputum -Scarce Presumptive Tuberculosis in HIV Patients in A Tertiary Care Center
Authors: Dr Mood. Rajeev Naik  , Dr Aravind Sai Kalinga  , Dr Earjala Raju  , Dr M. Nithya  , Dr Gourelly Latha  , Dr M. Narender
Published: April 2024

Background: HIV infection and TB are two major public health problems in most of the developing countries including India. TB also the most common opportunistic infection seen in HIV infected patients in India 1,2. Tuberculosis is a significant increase in the worldwide incidence of TB which is contributed majorly by HIV infection. AIM: To study the role of Sputum Induction to aid in the diagnosis of Smear Negative or Sputum Scare Presumptive Pulmonary Tuberculosis in adults with HIV. Material & Methods: Prospective hospital based observational study. The present study was conducted in the department of TB & Respiratory medicine, Osmania Medical College, Hyderabad. The subjects of the study were selected among the HIV positive with Presumptive Pulmonary Tuberculosis patients who visited the outpatient department or had been admitted in our hospital who agreed for voluntary participation. A total of 50 Presumptive Pulmonary Tuberculosis with HIV co- infection were taken as sample size. Results: The majority of cases (38 %) were in the age group of 31-40 yrs. Mean age of the study group population is 39.76 ± 9.24. The predominant symptom in the present study was loss of appetite. Out of 50 patients 34% (17 patients) were known Diabetic and 10% (5 patients) were known Hypertensive. Most of the patients in my study are smokers (40%). The mean CD4 count in the present study is 182.68. Majority (72%) of patients in the present study did not have previous history of TB. On General examination majority of the patients had Lymphadenopathy. Out of 45 adequate Induced sputum cases, 89% (40 cases) were Negative for Sputum AFB and whereas 11% (5 cases) were Positive for Sputum AFB. Conclusion: Sputum induction is a safe, simple and valuable procedure to obtain adequate sputum samples in suspected cases of pulmonary tuberculosis and can obviate the need for much sophisticated and invasive procedures like bronchoscopy. Sputum induction improves the diagnostic yield for AFB in patients unable to expectorate adequate sputum sample.
Comparative Study of Gestational Age Using Mean Fetal Kidney Length and Other Sonographic Fetal Parameters in Singleton Pregnancy After 24 Weeks
Authors: Dr. Karuna Guguloth  , Dr. BSV Sivaranjani  , Dr. M.Govind Naik
Published: April 2024

Introduction: To accurately estimate the fetus age and follow up on the growth of different fetal organs, it is vital to know the accurate date of birth. It also helps to prevent prenatal and postnatal complications for the newborn. It is common for antenatal mothers to be unaware of last menstrual period (LMP). In such situations, it would be difficult to calculate the delivery date. According to various studies, up to 30% of women were not sure of their LMP. The treating obstetricians would have to be very careful when the exact LMP is unknown in order to prevent post maturity and prematurity deliveries. Material And Methods: The present study is prospective comparative study of Department of Obstetrics and Gynaecology in Guntur Medical College and Hospital, Andhra Pradesh, India. After 24 weeks of gestational age are included who are at age between 20-35 yrs which is of 200 sample size in the year 2020-21. Clinical assessment of gestational age was done by palpating the fundal height of the patient. Following this using ultrasound, meam fetal kidney length (FKL) along with other fetal parameters were calculated. Result: In the present study, BPD ranged from 28-40 wks, whereas the mean BPD was 35.25+2.67 HC ranged between 27-40 and the mean BPD was 35.35+2.88 MKL ranged between 27-41 and the mean MKL was 35.93+3.49. Upon the composite of multiple parameters GA ranged between 27.8-39.6 and the mean was 3.5.36+2.7. Conclusion: The FKL is very much useful in assessing the gestational age. From our study we state that there is a significant correlation between fatal kidney length and the gestational age. Hence fetal kidney is appropriate in estimation of gestational age.
Normoglycemic Obese and Non-Obese Women From North India With Polycystic Ovary Syndrome And Anti-Mullerian Hormone
Authors: Dr. Ramkumar Boopathirajan  , Dr. R. Hemakairavi  , Dr. Mohamed Jainul Azarudeen
Published: April 2024

Objective: Anti-Mullerian Hormone, often known as AMH, has been linked to a number of pathological disorders affecting the ovary, one of which is polycystic ovarian syndrome (PCOS). These patients' obesity, BMI, and hyperandrogenism are the triggers for a rise in the number of tiny antral follicles, which in turn affects the amount of AMH secreted. Method: AMH levels were compared with clinical, biochemical, and hormonal profiles in obese and non-obese PCOS women from Department of Community Medicine, TRR Institute of Medical Sciences, TRR Nagar, Inole, Hyderabad, Telangana, India, for the purpose of this study. Results: For this investigation, 54 cases of normoglycemic PCOS women were included. Among the patients, 62 (57.4%) had a BMI under 25 kg/m2, while 46 (42.6%) were obese. 48 patients (44.4%) had AMH 10 ng/ml. AMH 5ng/ml and obese PCOS individuals had significantly increased mean fasting insulin (P=0.01). In non-obese PCOS patients with AMH levels less than 5ng/ml, mean serum LDL-c was considerably higher (P=0.01), and mean serum LH was significantly higher in non-obese individuals with AMH 10ng/ml. Conclusion: Low AMH can be a significant marker for PCOS, and it should be routinely evaluated both for the diagnosis of PCOS and for the management of patients who have the condition. This is true regardless of the patient's BMI.
A multicentric study on Clinical, microbiological and psychological aspects of human toxoplasmosis in pregnant women of South-East regions of India
Authors: Dr Smrutilata Sahoo  , Dr. Rajnikant Shukla  , Dr. Snehalata Mallick  , Dr. Swayanka Samantray  , Dr. Ashrumochan Sahoo  , Dr Roshni Dandapat
Published: April 2024

Introduction: Serological tests based on the detection of specific IgG and IgM antibodies are the primary diagnostic methods for Toxoplasma infection. Prompt diagnosis of maternal seroconversion during pregnancy is necessary to prevent transmission to the foetus, by means of specific treatment, and also to permit close monitoring of at-risk foetuses and neonates. Material and Methods: This prospective multicentric study was conducted to evaluate the seroprevalence of T. gondii in humans and to determine various risk factors and psychiatry comorbidity associated with the disease. During the study, samples were collected from randomly selected pregnant women at various centres. Sera were sent to laboratory for antibody detection by ELISA. Proper history was recorded and psychiatry evaluation was done. Results: Most of patients belonged to 31-40 years (28.3%) followed by 21-30 years (21.6%), 41-50 years (18.3%) and least were belongs to 15-20 years (15%). Most of the patients showed Fever,Lymphadenopathy, Abdominal pain as presenting symptoms. In our study, women reported higher scores of somatizations, depression and phobic anxiety. Eating of raw or undercooked meat and inappropriately washed vegetables were identified as two important risk factors for maternal toxoplasmosis. Conclusion: Although most immunocompetent individuals infected with toxoplasmosis remain asymptomatic throughout life, this parasite can cause many complications in immunocompromised patients and in pregnant women. Newborns presenting with congenital toxoplasmosis can be asymptomatic but can also developretinochoroiditis and serious CNS complications. So, if women conceive, they should be educated regarding their eating habits and the value of good hygiene at the first visit for antenatal care. Health education for women of childbearing age is extremely important to prevent maternal toxoplasmosis.
Obesity and Impact On Thyroid Hormone and Subclinical Hypothyroidism
Authors: Dr. Muth S. Bhaskar  , Dr. Jayachandran R.  , Dr. Rashmi K.P.  , Dr. Juby John
Published: April 2024

Background: Obesity is a metabolic disorder due to physical inactivity associated with increased consumption of calories. The excess calorie is stored as fat in adipose tissue, the fat loaded adipose tissue stimulates inflammatory pathway. The secreted inflammatory cytokines influence the sodium iodide transporter on the surface of thyroid gland. It causes decreased Thyroid hormone (TH) secretion & elevated Thyroid Stimulation Hormone (TSH). the energy metabolism of the body is regulated by TH, decreased TH secretion in obesity disturbs energy metabolism. Material & Methods: The study population are the patients attending OPD of medicine a tertiary hospital in Bhopal, Madhya Pradesh (Central India). Total 25 patients are selected for the study based on their anthropometric measurements (Weight, Height, BMI) confirmed them as obese. Of them 16 are males and 9 are females aged >35 years and are compared with equal number of age matched control population. Results: The values obtained after investigation of various parameters of study as well as control is analysed using SPSS software. The obtained mean, SD values of these parameters are as follows. Conclusion: The obesity due to excessive calorie intake with low physical activity deposits more fat into adipose tissue. The fat loaded adipocytes not only increases blood lipids but also aggravates inflammatory pathways. The secreted inflammatory cytokines (IL-1, 12,18, TNF- α , IFN influences thyroid function by a change in lodide transport across the thyroid gland.