bluuebunny/crossref_metadata_2025 huggingface dataset:
Utility of bilateral superficial cervical plexus block in thyroidectomy patients for post-operative analgesia
Authors: Shah Parth M. , Kheskani Divya N.
Published: November 2021

Background: Thyroidectomy is painful procedure hence multimodal analgesia is required. Superficial cervical plexus block can be used for analgesia in thyroid surgeries. USG guided cervical plexus block administration is safe and latest technique as a part of multimodal analgesia for thyroid surgery.Methods: After obtaining consent 60 ASA grade I-II adult patients undergoing elective thyroid surgery were included and randomly divided into two groups (group B)-0.25% bupivacaine and (group S)-normal saline. Induction and maintenance under general anesthesia carried out as per standard protocol. After Induction USG guided block was administered with the drug solution as per allocated group. After surgery, patients were extubated and shifted to recovery room. Vital parameters were monitored. Patients were asked about their pain based on the 11-point numerical rating scales (NRS) score. The NRS score and other variables were documented at 3rd hour, 6th hour, 12th hour, and 24th hour at wards after the end of surgery. Time since the end of surgery to the first analgesia request was documented together with total analgesia consumed in the first 24 hours. If NRS score was ≥4 inj. Tramadol iv in incremental doses of 25 mg was given until pain relieved.Results: Time to first dose of analgesia was higher in group B compared to group S. Total analgesic dose of tramadol during first 24 hours was lower in group B compared to group SConclusions: bilateral superficial cervical plexus block can be used as a part of multi-modal analgesia in patients of thyroidectoy.
Determinants of stress on resident physicians: systematic review and meta-synthesis
Authors: Kohar Ricky Cik , Pertiwi Junita Maja , Warouw Finny
Published: November 2021

Stress/burnout on resident physicians is common. Various determinants can be related to resident stress. This systematic review was conducted to determine how situational, personal, or professional determinants influence resident stress. We identified an English and Indonesia articles using online database including PubMed, Wiley Online Library, Google Scholar, Garba Rujukan Digital (GARUDA), and manually searching bibliographies of the included studies from January 01, 2001 until April 30, 2021. Three main search terms included are resident physician, determinant, and stress/burnout. Study selection included was peer-reviewed literatures of observational studies that discuss about stress determinants on residents from various year of training and medical specialties. Methodological quality of studies was assessed using Newcastle-Ottawa Scale adopted for cross-sectional studies. Data extraction conducted by 3 authors. All pooled synthesis were summarized based on narrative methods. Fifty-three cross-sectional, 1 prospective, and 1 combination of cross-sectional and longitudinal studies meet our inclusion criteria (n=29.031). Fifty-one percent are male, and the average age of the participants was 29 years old. The most stress/burnout validated tool used are Maslach Burnout Inventory. The average quality of study was moderate for cross-sectional studies. The main identified determinant was situational, the second was personal, and the latter was professional. The most stressor identified was ‘excessive working time per week, includes night shift, on-call, work on day off, and rotation more than 24 hours.’ Stress/burnout on residents closely related mainly to situational, followed by personal, and less by professional determinants. There was needed for an intervention to the educational program from institution in the future for better accomplishment.
Acute limb ischemia in COVID-19 patients and its rehabilitation: a case series from a tertiary care hospital in Central India
Authors: Harchandani Rohit , Kela Manoj , Bawa Abhishek , Rathod Ashish , Wajid Sheikh , Gupta Apoorv , Chaphekar Rohan , Bhandari Vinod
Published: November 2021

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a highly transmissible and infectious virus. It belongs to the family coronavirus and it is a single strand positive sense virus. There are many theories which relate to the origin and transmission of this virus and hence the virus has been tagged with many names according to various taxonomical guidelines. The conventional clinical spectrum of this infection includes cough, fever, dyspnea, anorexia and gastrointestinal symptoms. It has been seen during the course of this disease that there are also some properties relating this virus to the hypercoagulability in the disease spectrum. The cases involving arterial and venous thromboembolism are not rare. This case series is a collection on three such cases from the red zone (zone separated for COVID-19 infected patients) of a tertiary care hospital in central India which showcase acute limb ischemia in patients infected with SARS-CoV-2.
A rare presentation of immune thrombocytopenic purpura
Authors: Yadav Ponvijaya , Gokhale Vijayashree S. , Parati Rupesh , Mehta Keyuri
Published: November 2021

Immune thrombocytopenic purpura (ITP) is defined as a hematologic disorder, characterized by isolated thrombocytopenia without any apparent cause. Some patients may be diagnosed during routine blood investigations or may present with bleeding diathesis. Treatment required for moderate to severe thrombocytopenia or those with bleeding manifestations. We present a case of 43 year old male, sputum positive pulmonary tuberculosis on isoniazid (H), rifampin (R), pyrazinamide (Z), and ethambutol (E) (HRZE) with persistent thrombocytopenia. He developed hepatitis hence isoniazid (INH) and rifampicin were stopped. He had fever, rash, purpura, hematuria and blood tinged sputum with platelet count of 10,000. 4 random donor platelets (RDPs) given. He suffered from mild COVID-19 infection and recovered in 2 weeks but platelets remained low. Bone marrow examination was suggestive of ITP. Inspite of steroid therapy no improvement was seen. Later was treated with injection romiplostim, and started on systemic lupus erythematosus (SLE) regimen for tuberculosis and discharged with regular follow up. Last platelet count being 1,20000/dl, liver function tests normal and now restarted on HRZE.
Transfusion management in a pediatric patient with febrile neutropenia with red blood cell autoantibodies: a case report
Authors: Jain Ashish , Ramakrishnan Sharanya , Tripathi Parmatma Prasad , Hans Rekha , Bansal Deepak , Sharma Ratti Ram
Published: November 2021

Febrile neutropenia is a common complication of chemotherapy especially in hematological malignancies associated with sepsis or severe infection. We report a case where a seven-year-old girl with T – cell acute lymphoblastic leukemia (ALL) developed febrile neutropenia (absolute neutrophil count - ANC <500/µL). Patient developed transient red blood cell (RBC) autoantibodies which interfered with compatibility testing and posed a challenge in donor selection for granulocyte transfusion. Direct antiglobulin test (DAT) and compatibility testing were done by column agglutination technique (CAT) using polyspecific anti-human globulin gel cards. Antibody screen was also done by CAT using 3-cell panel. Granulocyte concentrate was collected from eligible donors after taking an informed consent using a cell separator based on continuous flow principle. The patient’s blood group was AB RhD positive, however, the auto-control was positive (2+), DAT was positive (1+) but the antibody screen was negative. Monospecific DAT revealed the characteristic of antibody to be IgG (2+). The donor for granulocyte harvesting was selected on the basis of adopting a least incompatible donor approach. During her hospital stay she was transfused with four granulocyte concentrates, and other blood components without any adverse events. The patient’s blood culture was sterile on day 33 of hospital stay and subsequently she remained afebrile and finally discharged on day 41 in a hemodynamically stable state. The hemogram was- Hb:10.7g/dL, Total leucocyte count (TLC): 5610/µL, ANC: 4375/µL, PLT: 22000 /µL. This case draws a special attention to the importance of serological testing in selection of donor for granulocyte transfusion.
Classical Cornelia de Lange syndrome in a neonate
Authors: Tawab Abdul , George Madhu , Zacharias Ann Mary
Published: November 2021

Cornelia de Lange syndrome is a rare developmental disorder syndrome involving multiple systems characterized by facial dysmorphism limb deformities, hirsutism, cardiac defects, growth and cognitive retardation, and gastrointestinal abnormalities. The features of this disorder range from mild to severe.  We present here a case of preterm newborn with Classical Cornelia de Lange syndrome with heterozygous mutation in NIBPL gene.
Rheumatoid arthritis onset after COVID-19 infection: a case report
Authors: Safar Thafar S. A. , Katay Karmen B. , Khamis Reem H.
Published: November 2021

At the end of 2019, coronavirus disease (COVID-19) outbreak is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV2). Worldwide researchers and physician try to explore the mechanisms of damage induced by virus, they focus on the short-term and long-term immune-mediated consequences induced by the virus infection. Every day discover a new pathological condition induced by virus and new symptoms and disease may occur after recovery from disease. Our case report is 41 years old, Indian lady who presented to our primary health care centre complaining of multiple small hand joints pain, both elbows and knees pain with swelling of them and prolonged morning stiffness, diagnosed seropositive rheumatoid arthritis (RA) (arthritis, positive rheumatoid factor (RF), and X-ray changes) after 1 month recovery from COVID-19 infection. She did not have any joint pain and she had negative RF before COVID-19 infection with no family history of RA.
Chronic myeloid leukemia on imatinib with recurrent sub-dural haemorrhage
Authors: Bhavani Ambati , Dattatreya Palanki Satya , Shyamala Vinukonda
Published: November 2021

Imatinib is an FDA approved first-line treatment for Philadelphia-positive CML. It is a selective tyrosine kinase inhibitor specifically targeting BCR-ABL, c-KIT, PDGFRA. It has been reported with low incidence of adverse effects and high tolerability, with haemorrhagic events being a rare complication. We report here a case of 51-year-old female patient with chronic myeloid leukemia who was on high dose imatinib experienced recurrent sub-dural haemorrhage. This case report emphasizes on the need to consider Sub dural haemorrhage as an unusual cause of headache associated with vomiting in a patient taking high dose of imatinib.
Bilobed gallbladder: a rare congenital anomaly of the biliary system
Authors: Roul Pradeep Kumar , Saini Aditi , Agarwal Srishti , Verma Prashant Kumar , Syed Anjum
Published: November 2021

Duplication of the gallbladder is a rare congenital anomaly, which Boyden first illustrated in 1926. No additional risk of cholelithiasis or malignancy with this congenital anomaly was documented. However, this congenital anomaly is associated with more risk for complications during and after laparoscopic cholecystectomy. So, preoperative diagnosis is essential in identifying anatomical abnormalities to avoid biliary injuries at the time of surgery or the performance of an incomplete operation. The removal of an asymptomatic double gallbladder remains controversial. Here, we are reporting a case of the incidentally detected duplex gallbladder in a teenager and review the literature that will enrich the reader’s knowledge regarding this rare congenital anomaly.
Use of face mask in COVID-19 pandemic-a review
Authors: Swain Santosh Kumar , Jena Pragnya Paramita
Published: November 2021

The current novel corona virus disease 2019 (COVID-19) is a highly infectious disease of the respiratory tract and rapidly spreading all over the world in short span of time. In current COVID-19 pandemic, use of the face mask is becoming usual and ubiquitous for both health care workers and public individuals. Wearing face mask is one of the non-pharmaceutical interventions which need minimum cost and provide dramatic response for preventing the COVID-19 infection. Limited availability of the vaccine and inadequate supply of therapeutic options, face mask use is an important part for public health measures for restricting the COVID-19 spread. Regardless of the debate among medical community regarding global face mask production shortage, a greater number of countries in the world are moving ahead with recommendations or mandates for using face mask in public. As currently global shortage of N95/FFP2 respirators and surgical masks for use by health care workers in the hospitals, simple cloth masks will act as a pragmatic solution for the use of the public. General public often use the surgical mask or even filtering facepiece (FFP) masks irrespective of their need, resulting unnecessary shortage for needy individuals those are exposed to the patients or those are health care workers. So, this review article will clarify the indication of the different types of masks and their rational use in the current COVID-19 pandemic.
Relationship between coronavirus disease 2019 and Parkinson’s disease
Authors: Musheyev Yakubmiyer , Ftiha Farage , Jradeh Henry
Published: November 2021

New literature shows that COVID-19 has negative effects on patients with Parkinson’s disease (PD). COVID-19 is known to produce neurological manifestations and infects the central nervous system. Similarly, the virus also causes neuromuscular complications and involves the peripheral nervous system. Studies show PD patients with a severe COVID-19 infection have a higher mortality rate, worsening in symptoms, and require an increase in drug dosage. These studies suggest that COVID-19 may lead to a more rapid onset of PD, or may increase the risk of developing PD. Furthermore, researchers observed that Motor and nonmotor symptoms significantly worsened in PD patients with COVID compared to PD patients.
Repositioning maneuvers in benign paroxysmal positional vertigo: how do we improve outcomes?
Authors: Banerjee Tapas Kumar
Published: November 2021

Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular disorder. A series of meetings with clinicians treating BPPV were conducted to seek their views on improving outcomes in patients with BPPV. BPPV is primarily treated by Otolith repositioning maneuvers (ORM) to help to move the otoconia out of the canal and lead it back to the vestibule. Although repositioning maneuvers are effective in BPPV management, some patients experience residual dizziness, postural instability, recurrences, and psycho-emotional consequences after about 1 month after repositioning. An important and useful non-pharmacological intervention for patients with balance disturbances is Vestibular rehabilitation (VR), which includes vestibular adaptation, habituation and substitution, and patient education. Repositioning devices and mastoid vibration could help a subgroup of patients with BPPV who do not respond to conventional management. Betahistine dihydrochloride accelerates the recovery of function of vestibular system by improving blood flow in the inner ear, and normalization of the function of motion sensitive hair cells is faster. Betahistine-treated patients may have faster recovery, lesser recurrence, and longer relief of symptoms. The use of betahistine in combination with maneuvers can help prevent the development of residual dizziness.
The efficacy of primary closure following incision and drainage of lactational breast abscess over traditional open method
Authors: Parvin Ruksana , Sharif Ahmed , Parvin Mosammat Bilkis , Iqbal Kazi Sohel , Kohinoor Golshan Ara , Mustica Riddita , Hossain M. Sourav
Published: November 2021

Background: The incidence of breast abscess ranges from 0.4 to 11% of all lactating mothers. Although breast abscess is a serious common complication of mastitis with high morbidity rate, there is a lack of high-quality randomized trial to demonstrate the best treatments.Methods: The Study was conducted in the Department of Surgery of Universal medical college and hospital, Dhaka, Bangladesh and MH Samorita hospital and medical college. It was a randomized controlled trial to see the efficacy of primary closure following incision and drainage of lactational breast abscess over traditional open method. Total 120 population were randomly selected in group A (60 patients) and group B (60 patients) and data was collected with their signed ethical consent. The study was conducted from January 2014 to December 2019. Collected data were classified, edited, coded and entered into the computer for statistical analysis by using Statistical package for social sciences (SPSS) version 22.Results: In patients of group A, most breast abscesses healed successfully with a nicer circumareolar scar, earlier healing, lesser number of hospital visits and lower total cost as compared to patients in group B. There was early resumption of breastfeeding and better patient satisfaction seen in group A.Conclusions: Primary closure of lactational breast abscess following incision and drainage is an effective modality of treatment of lactational breast abscess and it should be the first line of treatment, especially for larger and multilocular breast abscesses while traditional incision and drainage should be reserved for abscesses with gangrenous skin changes, where primary closure is not justified.
Awareness of diabetic foot disease among patients with diabetes mellitus in Al-Ahsa Saudi Arabia
Authors: Aldhafar Abdulaziz S. , Abdullah Mohamed , Althafar Abdulaziz K.
Published: November 2021

Background: The prevalence of diabetes mellitus (DM) in Saudi Arabia is 18.3% in 2020. One of the most common complications that affects diabetic patients is diabetic foot disease (DFD). Patient education is the most effective way to reduce the complications of DFD.Methods: A cross-sectional study was conducted in the period from January to May 2021. A pretested standardized questionnaire was used to collect information upon knowledge, attitude and practice toward diabetic foot care. Data entry was performed using SPSS.Results: The responses of 480 of which 294 male and 186 female, 41.6% have high school degree, 19.3% have bachelor’s degree and 2.2% have master or Ph. D. degree. The mean age of the respondents was 47 years. The 58% of the participant agreed that they might develop reduce flow to their feet. half of the participant were not aware that smoking can reduce blood flow in their feet. There were only 2.3% of the respondents attended a class on how to care of the foot. Participants who received information about foot care from a nurse and physician were 23% and 9.2% respectively. The 97.5% of the participant would like to know how to care for their foot. 75.8% of participants walk barefoot and 42.2% use a comfortable coated shoe.  Conclusions: Participants have inadequate knowledge, attitude and practice about DFD. providing a structured educational program about diabetic foot care has significant impact on diabetic patient to improve their knowledge and practices and to motivate them to have a positive attitude toward diabetic foot care.
Impact of COVID-19 pandemic on outcome of acute appendicitis: a retrospective analysis
Authors: Patil Linganagouda S. , Jagadeesha Reena
Published: November 2021

Background: Acute appendicitis is the most common abdominal surgical emergency. Lockdown and stay-at-home orders are strategies that were implemented globally during the acute pandemic period of COVID-19 to prevent disease dissemination, health system overload and mortality. However, there are concerns that patients did not seek necessary health care because of these rules.Methods: Retrospective observational study was conducted on patients who presented with acute appendicitis from January 2020 to May 2020. They were classified according to the time of presentation that is before declaration of the state of alarm (pre-COVID-19), and after its declaration (post-COVID-19) in India (24 March 2020). An evaluation was made of demographic variables, complications and duration of hospital stay in both the groups.Results: 45 patients were included, 20 in pre-COVID-19 group and 25 in post-COVID-19 group. In post-COVID-19 group, the interval from onset of symptoms to admission was 65.0 hour, which is significantly longer than the 17.3 hour interval noted in pre-COVID-19 group (p<0.001). The prevalence of complicated appendicitis after the epidemic outbreak was significantly higher than before the outbreak (52% versus 20%, p<0.001).The mean hospital stay was longer in post-COVID-19 group (5.6±5.9 versus 3.2±4.3 days; p=0.041).Conclusions: COVID-19 pandemic influenced the time of diagnosis of appendicitis, as well as its course, and mean hospital stay. Complicated appendicitis was more common in patients with acute appendicitis after the outbreak of COVID-19 pandemic.
Ultrasound guided direct puncture percutaneous nephrostomy: a single tertiary centre observational study
Authors: Rulaniya Suresh Kumar , Swain Samir , Neniwal Vishal Kumar , Bhalothia Shweta , Tonge Kishor , Agarwal Piyush , Khan Zaid Ahmad , Hota Datteswar
Published: November 2021

Background: Percutaneous nephrostomy (PCN) is indicated to drain the upper urinary tract collecting system in cases of obstruction. Objective of our study is to evaluate the safety and efficacy of Ultrasound guided direct puncture PCN in our populations.Methods: This observational study was conducted from May 2020 to April 2021in department of urology and renal transplant. The total 65 patients with upper urinary tract obstruction requiring PCN were enrolled. All parameters were recorded and statistical analysis was performed using the Statistical package for the social sciences (SPSS 16.0) for windows.Results: In our study Ca Cervix with ureteric infiltration (35%) was the most common indication for PCN tube placement. Majority of patients (83%) had Grade IV and Grade III hydroneprosis. Single attempt for tube placement was sufficient most of the time in (86% cases). Direct Puncture PCN tube placement was successful in 62 (95.4%) cases. The mean duration of procedure was 12.4 minutes. Loin pain was the most common procedure related complication observed in 58 patients. There was no evidence of visceral injury, no need of blood transfusion in post procedural duration in our study.Conclusions: USG guided direct puncture PCN technique is simple, low cost, less time consuming, less chance of loss of tract and effective procedure for drainage of urine in case of upper urinary tract obstruction. We recommended this procedure in grade III and IV hydronephrosis and this procedure suitable for developing countries like India because of procedure related low cost.
Spectrum of presentation and prognostic factors in non-traumatic small bowel perforations
Authors: Yadav Anoop , Kumar Satish , Marwah Sanjay , Argal Narottam S. , Yadav Chander M. , A. Sethu R. P. , Singh Anamika , Bhardwaj Madan Gopal
Published: November 2021

Background: The small bowel perforation peritonitis is one of the main causes of generalized acute peritonitis in developing countries.The aim is to find out the prognostic factors affecting the mortality and morbidity of non-traumatic small bowel perforations.Methods: A total of 50 patients of any age and either gender of non-traumatic small bowel perforation peritonitis were included and studied prospectively. The prognostic evaluation was assessed by the impact of pre-operative prognostic factors and per operative findings on post-operative complications and mortality.Results: One third of the patients were of 20-30 years of age followed by 18% who belonged to 10-20 years age group. Operative findings revealed mean duration of surgery was 2 hours. Majority of patients (33) had bilio-purulent peritonitis. Post-operative pulmonary complication revealed 56% (28 out of 50) patients were having pulmonary complications. Post-operative wound complication showed surgical site infection as the most common complication noted and managed by sending wound culture and changing antibiotics. Second most common was burst abdomen managed initially by dressing and thereafter secondary wound closure. Delay in intervention (DII) had significant correlation with world society of emergency surgery (WSES) score and amount of peritoneal fluid.Conclusions: Most common cause of non-traumatic small bowel perforation was typhoid ileal perforation with most common presentation being pain abdomen. The significant factors defining the outcome of these patients were volume of intra-peritoneal fluid (purulent/fecal) >1000 ml, WSES score >6 and Mannheim’s peritonitis index (MPI)>18.
Comparision of dexmedetomidine and clonidine with hyperbaric bupivacain in spinal anaesthesia
Authors: Agrawal Anshul , Jain Sunita , Goyal Ashish
Published: November 2021

Background: Alpha-2 adrenergic agonists used as adjuvant to spinal anaesthesia produce substantial sensory and motor blockade of bupivacaine. This study was planned to compare the sensory and motor blockade characteristics of intrathecal combinations of adjuvants dexmedetomidine and clonidine with hyperbaric bupivacaine in the cases who underwent lower limb surgery under spinal anaesthesia.Methods: This was prospective, randomized, double blind study. 90 patients of age group between 18-60 years, ASA grade I and II were allotted into 3 equal groups. Group B received 15 mg bupivacaine plain, group BD and BC received dexmedetomidine (5mcg) and clonidine (50mcg) as adjuvants to bupivacaine respectively.Results: The duration of 2 dermatome regression time, sensory blockade and motor blockade were longest in dexmedetomidine group (129.37±4.87; 386±58.43; 353±48.87) in compared to clonidine (109.77±5.95; 296.53±57.19; 269.7±51.2) and bupivacaine group (81.03±6.83; 211.1± 30.47;181.03±20.8). Both drugs do not affect the peak level of sensory blockade, sensory block onset and motor block onset time. Dexmedetomidine and clonidine do not cause sedation in intraoperative and postoperative period.Conclusions: We conclude that addition of dexmedetomidine and clonidine in spinal anesthesia with hyperbaric bupivacaine increase the duration of ‘2 dermatome regression’ time, sensory and motor blockade and both are more with dexmedetomidine than with clonidine.
Efficacy of antiglide plate in vertical shear fractures of medial malleolus due to supination adduction injury around ankle: a prospective clinical study
Authors: Arora Kamal Kumar , Kapila Rajesh , Chaudhary Priti , Singh Raminder , Kapila Sarika
Published: November 2021

Background: Ankle fractures represent 10% of all fractures with an incidence of around 137/100000 population per year, making these the second most common lower limb fractures after hip fractures. Increasing age, obesity and alcohol abuse are the major causal factors for the fractures around the ankle joint. These are typically low energy injuries with the majority occurring due to simple falls or sport. The aim was to open reduction and internal fixation of these with an antiglide plate.Methods: The present prospective study was carried out at government medical college Amritsar, Punjab in 25 patients of same demographic profile, March 2018 to December 2020 after having the clearance of ethical committee. All the patients after careful assessment of the injury both clinically (pain, swelling, deformity, any blisters) and radiologically (type of fracture, that is, vertical shear fracture of medial malleolus) were internally fixed under spinal anesthesia, with an antiglide plate after reduction of the fracture fragments.Results: The results were assessed accordance with Olerud-Molander ankle score (OMAS). We achieved excellent to good results with an average OMAS score of 80/100 in the present study.Conclusions: The open reduction and internal fixation of vertical shear fractures of medial malleolus with an antiglide plate is an effective way of management of these fractures. It ensures maximum stability and more so safeguards against loss of reduction or the implant failure under axial loading and at the same time ensures the timely union of such fractures without any significant complications.
Study to determine Wells criteria as a reliable clinical tool in diagnosis of deep vein thrombosis: a one year cross-sectional single centric hospital based study
Authors: Togale Manoj D. , Gupta Pulkit
Published: November 2021

Background: Venous thromboembolism which encompasses deep vein thrombosis (DVT) and pulmonary embolism (PE) is one of the major cardiovascular causes of death along with myocardial infarction and stroke. DVT is a common problem in non-ambulatory and hospitalized patients. It is a major cause of morbidity and mortality in these patients. Venous thromboembolism mimics other illnesses making its diagnosis difficult. In such circumstances clinical improvement often fails to occur despite standard medical treatment of the concomitant illness.Methods: A prospective cross-sectional study was conducted at tertiary care hospital in which 40 patients with complaint of limb swelling were included. Risk was calculated according to the wells criteria and confirmed with color Doppler of the affected limb.Results: Majority of people were more than 50 years with male preponderance and with history of smoking present. Subjects had leg swelling with edema and calf tenderness. Results were well established in favor of Wells criteria for making diagnosis of DVT. This criterion showed 100% sensitivity with a negative predictive value of 100% and an accuracy of 90%.Conclusions: This criterion can help the clinicians to treat the disease before it takes a violent course and help the patients live a healthy life. The present study was done in a small proportion of patients. It is highly recommended that thorough studies and researches be conducted so that modern medicine can be highly efficacious, with newer techniques and procedures which can be beneficial for the patients.
Assessing the effectiveness of the full outline of unresponsiveness scale and the Glasgow coma scale in patients of traumatic head injury
Authors: Ansari Fahad , Rai Arvind
Published: November 2021

Background: The Glasgow coma scale (GCS) is the most commonly used scale while the full outline of unresponsiveness (FOUR) score is a new validated coma scale in the evaluation of the level of consciousness in head injury patients. The aim of the study was to compare and assess the effectiveness of the FOUR score and the GCS in patients of traumatic head injury.Methods: This was a prospective observational study conducted in the department of surgery, Gandhi medical college, Bhopal during a 2 year period in which 100 patients of traumatic head injury were evaluated. The FOUR score and GCS score of these patients were assessed on admission and outcome followed for 2 weeks.Results: The mean age group of 100 patients was 25-45 years with 79% male and 21% female patients. The FOUR scale was found to have a marginally higher sensitivity of 65.6% while the GCS had a sensitivity of 64.2%. The FOUR scale however had a higher specificity of 71.5% compared to 66.4% of GCS. The Youden index showed that FOUR scale (46%) has a better prediction for death than GCS (35%). FOUR had a higher accuracy of 75% than GCS with an accuracy of 65%.Conclusions: Both FOUR score and GCS are valuable scales in assessment of traumatic head injury. The FOUR scale however is more accurate than the GCS in predicting outcome of head injury patients.
Human epidermal growth factor receptor 2/neu and the clinico-pathological profile in breast cancer: an observational study at a tertiary care hospital in Central India
Authors: Shukla Shikha , Ansari Fahad
Published: November 2021

Background: Breast cancer is the most commonly occurring cancer in women and the second most common cancer overall. Owing to a unique pattern of presentation in terms of clinical and biological features, finding their mutual association may be important and may help predict prognosis. HER2 (human epidermal growth factor receptor 2)/neu is one such important immunohistochemical factor that is considered to be more prevalent amongst Indians and therefore makes up for an emerging area for studies. The study aimed to assess the patients of breast carcinoma in terms of their HER2/neu statuses and find out their association with clinical parameters.Methods: This was a prospective comparative study conducted in department of surgery, Hamidia hospital, Bhopal, India, with a total duration of 1 year between November 2018 to September 2019 including a total of 98 consecutive in house breast carcinoma patients.Results: A total of 98 breast cancer patients were tested for HER-2/neu gene presence. Of these 25 (25.5%) samples tested positive and 73 (7.48%) tested negative. A comparison of the two groups revealed that none of the clinic-pathological factors tested were found to have a statistically significant association with the HER2/neu status.Conclusions: It appeared that there is no defining factor in terms of clinic-pathological presentation that helps to separate significantly HER-2/neu positive with HER-2/neu negative cases with breast cancer. Still, immune-histochemical marker analysis should be an integral part of the overall work up of the breast cancer patients because of its both prognostic and therapeutic application and significance.
Durability and versatility of free lattismus dorsi muscle flap in leg defects in tertiary care hospital
Authors: Islam Abu Faisal M. Ariful , Ahmed M. Iqbal , Uddin M. Salah , Hamid M. A.
Published: November 2021

Reconstruction of the legs and feet is challenging. Because of the composite tissue defects, inadequate and tight local tissues and poor circulation, soft tissue scarcity around the lower portion of the leg presents a significant challenge to the reconstructive surgeon. The aim of this study was to assess the outcome of free Lattismus dorsi (LD) muscle flap used for soft tissue reconstruction of leg defects. This prospective non-randomized study was conducted on 13 patients with leg defects of different causes attended emergency unit and outpatient clinic of plastic surgery department of plastic surgery and burn unit, Dhaka medical college hospital (DMCH) in the period between July 2017 and June 2018. Durability of coverage, flap success, infection and overall satisfaction were studied. The age distribution of the study population highest number of patients (46.15%) were in middle (31-40 years) age group whereas lowest are in older group (>51 years). Highest number of patients (84.61%) were standard myocutanous type of flap whereas lowest were in (15.31%) were chimeric flap and partial latissimus muscle flap. There were one case of total flap loss. Two patients had seroma formation among them one patient had partial necrosis. The outcome of reconstruction of n=13 patients 76.92% patients discharged with excellent recovery, (15.38%) patients discharged with good outcome, 1 (7.69%) patients had total flap loss. Flap is easy to dissect, anatomical variation is rare, long pedicle length which allow to anastomose with suitable recipient artery and finally donor morbidity is negligible.
Outcome of major abdominal surgeries in COVID-19 positive patients with awake anaesthesia: surgeons’ perspective
Authors: Thakuria Kailash K. , M. Naveen Kumar , Boro Monmohan
Published: November 2021

In view of the COVID-19 pandemic, the use of locoregional anaesthesia has gained popularity as the greatest number of the major abdominal surgical cases which were usually done under general anaesthesia (GA) is now shifted towards awake anaesthesia due to fear of aerosol generation. In a COVID era, with evolving risk of aerosol generation in surgery under GA and the urge for reserving ICU beds for needy patients, this study was undertaken to assess the adequacy of surgery and other benefits with awake anaesthesia. A retrospective observational study for 8 COVID-19 positive patients, undergoing emergency major abdominal surgeries with locoregional anaesthesia in pre-operatively diagnosed COVID positive from May 2020 to May 2021 was conducted. Low to medium risk patients (ASA 1-2) were considered following assessment by anaesthesiologist. We retrospectively analysed data including perioperative events, post-op follow up. The mean operative time was 103 minutes (minimum 50 minutes; maximum 170 minutes). In one case, conversion to general anaesthesia was necessary. Post-operative pain was always well controlled. None of them required postoperative intensive care support. No perioperative major complications (Clavien Dindo ≥3) occurred. Early readmission after surgery never occurred. In our experience in the COVID-19 era, RA may help to limit the intubation-related risk of contagions inside theatres and could be feasible, safe, and painless alternative to GA in selected cases and this approach could become part of an ICU-preserving strategy.
Left Amyand’s hernia with inflamed appendix and sealed of perforated caecum an unusual case
Authors: Mohite Reshma Bhalchandra , Iyer Vishaka , Beedkar Anant N. , Jadhav Sarojini
Published: November 2021

Amyand’s hernia is defined as the hernia with appendix normal, inflamed or perforated as content. 1% of inguinal hernias are Amyand’s and amongst them 0.1% contains inflamed appendix. Commonly encountered on right size due to anatomical position of appendix. Left Amyand’s is rare and associated with intestinal malrotation, situs invertus and mobile caecum. Here, we presented an interesting case of left irreducible hernia in 70 years old gentleman with no signs of acute obstruction or strangulation, patient underwent emergency laparotomy in which hernial sac contents were inflamed ileal loop, inflamed appendix and perforated caecum in 70 years old man is rare presentation and not reported in any literature as per our knowledge. Resection of inflamed bowel loop with ceacum done along with ileo ascending anastomosis with primary tissue repair done. Post-operative period was uneventful. Hernia sac contents are most of the time surprising and their management sometimes differ according to the content. Appendix in hernia sac is found in 1% of all hernia but lack of facility for the pre-operative diagnosis and varied presentation it is challenging to diagnose and operate accordingly.
Intussusception in adults: the case report of a rare cause of intestinal obstruction
Authors: Singh Prawin Kumar , Sahu Rakesh Kumar
Published: November 2021

Intussusception of the bowel is defined as the telescoping of a proximal segment of the bowel within the lumen of an adjacent segment. This condition is a common cause of intestinal obstruction in children below two years of age. It is considered a rare cause of intestinal obstruction in the adult. It accounts for 5% of all cases of intussusception and 1-2% of all cases of intestinal obstructions in the adult population. Almost up to 20% of cases are idiopathic and they are not having any lead point pathology. The rest of the cases are caused by organic lesions like Meckel’s diverticulum, benign and malignant lesions, metastatic neoplasm, intestinal polyp, etc. In adults’ preoperative diagnosis is difficult and a definitive diagnosis is made at laparotomy. Computerized tomography is the most sensitive diagnostic modality for this condition.
An unusual case of small bowel obstruction secondary to internal herniation of distal ileum through a rent between adhered inflamed vermiform appendix and appendices epiploicae
Authors: H. G. M. Rudraiah , Davis Benita
Published: November 2021

Intestinal obstruction secondary to an internal hernia is rare and that occurring through a rent between the adhered inflamed vermiform appendix and appendices epiploicae of the proximal caecum is so rare that this case was the first of its kind ever to be reported. Such a cause for obstruction should be suspected in a patient with a virgin abdomen with no history/clinical features of an obstructing external hernia or abdominal tumor. A 28 year old man presented to the ER with features of intestinal obstruction, in whom CECT abdomen revealed multiple dilated small bowel loops with breaking-of seen in the region of the terminal ileum. Surgical exploration revealed internal herniation of the distal ileum through a rent between the adhered inflamed vermiform appendix and the appendices epiploicae of the proximal caecum; reduction of which was sufficient to relieve the obstruction and demonstrate healthy reperfusion. Adhesiolysis, epiploicae appendectomy and appendectomy was done with no other points of obstruction along the small bowel. Due to its rarity, non-specific presentation pattern and limited usefulness of imaging for diagnosis, a high index of suspicion with prompt early surgical exploration is a must for a successful outcome in such cases intestinal obstruction; especially in a virgin abdomen.
Competences of polish nurses in the field of prescribing medications: A systematic review
Authors: Kasperska-Dębowska Paulina , Oleksy Eliza , Wojtczak Anna , Wojtysiak Katarzyna , Dreliszak Jakub , Wielgus Adriana
Published: November 2021

Purpose: The purpose of the following systematic review is to present polish regulations in terms of education, acquiring competencies in the field of prescribing drugs and medical devices.

Methodology: The following review can be helpful to conduct comparative meta-analyses. Internet System of Legal Acts, PubMed, Google Scholar research was used to analyze the topic. The selected keywords were used to find information sources: law, competence, nurse, prescribing, medication, medical devices. Articles were selected according to regulations in Poland in terms of education, acquiring competencies in the field of prescribing drugs and medical devices.

Main findings: The increase in nurses' competencies is equivalent to a greater need for knowledge and new knowledge acquired. Nurses take part not only in care and treatment, but also takes independent actions. In such enormous responsibilities, it is crucial to focus on the development of skills. Thus, a competent nurse is interested in continuous professional and personal growth and provides patients with high-quality nursing trustees.

Implications of this study: The results should be considered in health care units, especially Primary Healthcare Units. The paper indicates the regulations in terms of education, acquiring competencies in the field of prescribing drugs which should be revised by personnel and implemented to improve the work of the healthcare unit.

Novelty in this study: There is a lack of systematic reviews of the regulations in Poland in terms of education, acquiring competencies in the field of prescribing drugs and medical devices. The paper is an attempt to assess the topic.
Fee for issuing alcoholic beverages for sale in the municipalities of the Kielce poviat
Authors: Rogalska Joanna
Published: November 2021

Purpose of the study: The aim of the article is an analysis of revenues for fees for permits for the sale of alcoholic beverages in the own income of municipalities of the Kielce poviat in 2018-2020. It is to enable the answer to be given about the role of the fee for issuing a permit for the sale of alcohol in the incomes of municipalities' own.

Methodology: The work was based on the analysis of RB 27S reports on the implementation of the budget income plan of the surveyed municipalities, analysis of internal materials of these units, normative acts and the Local Data Bank

Main findings: The data presented in the paper shows that the share of revenues from fees for the permit to sell alcohol in own income does not exceed 1.7% and has a downward trend. However, the actual revenue from the levy shows slight fluctuations over the period considered. Moreover, it does not matter whether we are dealing with a rural or an urban-rural commune.

Application of the study: The following study concerns an important aspect of financing the activities of municipalities. Taxes and fees are the most important revenues in budgets. Each decision of the local government authorities has an impact on the level of income. It may lead to a lack of funds for the implementation of own tasks. The year 2021 may be interesting in terms of income from the fee under study due to the possibility of applying a fee exemption or postponing its payment resulting from the provisions of the Act of March 2, 2020 on special solutions related to the prevention, prevention and combating of COVID-19, other infectious diseases and the resulting crises. It is not an easy decision, because such action reduces the revenues to the commune's budget. Due to the fact that for the implementation of tasks for which the funds from the fee were provided, it will have to be financed with other income.

Originality/Novelty of the study: The importance of the financial stability of local government units is an extremely important topic. Topics related to budget planning are essential for the long-term balancing of the demand for funds reported by local governments in relation to the efficiency of funds left at the disposal of local authorities. As a consequence, the subject of the study was the analysis of the dynamics and structure of local authorities' income from the point of view of the selected source of income. The article can inspire further research in the field of local government finance and contribute to other interesting scientific studies.
Investigation of Toxin Profiles of Methicillin Resistant and Sensitive Staphylococcus aureus Strains Isolated from Various Clinical Specimens
Authors: BAYIRLI Mücella , ASLANTAŞ Özkan , ÖZER Burçin
Published: November 2021

Aim: This study aimed to investigate the superantigenic (SAg) toxin, exfoliative toxin (ET), hemolysin (HLY), leukotoxin (LUK) genes and accessory gene regulator (agr) types in Staphylococcus aureus isolates from various clinical materials.
Material and Methods: A total of 190 S. aureus isolates were investigated for the presence of toxin genes, mecA gene and agr types using by polymerase chain reaction (PCR).
Results: mecA gene was detected in 87 (45.8%) isolates. Of the 190 S. aureus isolates examined, 83.7% (n=159) were found to be positive for SAg genes. The seg (41.1%) was determined to be the most common toxin gene, followed by sei (38.9%), selo (38.9%), selm (28.4%), sea (%25.8), and tst (18.4%) genes, respectively. Seventy one different SAg toxin profiles were identified. Type I νSaβ encoding seg, sei, selm, seln and selo was the most common mobile genetic element (MGE), which was detected in 37 isolates (19.5%). The hla, hlb, hld, hlg and hlg2 genes were detected in 92.6% (n=176), 1.6% (n=3), 98.9% (n=188), 1.1% (n=2) and 31.6% (n=60) of the isolates, respectively. The pvl gene was detected in 12.6% (n=11) of methicillin resistant S. aureus (MRSA) and 14.6% (n=15) of methicillin sensitive S. aureus (MSSA), respectively (p=0.701). While none of the isolates carried lukM gene, 67% (n=69) of MSSA and 69% (n=60) of MRSA isolates were found to be positive for lukED gene (p=0.519).
Conclusion: High occurrence and diversity of toxin genes among S. aureus isolates could be explained by horizontal transmission of toxin genes through MGEs.