bluuebunny/crossref_metadata_2025 huggingface dataset:
Association of serum uric acid with left ventricular ejection fraction: A retrospective insight from a tertiary care hospital of North East India
Authors: Gupta Prabir Kumar , Boro Anup Kumar , Paul Biplab , Rahman Habibar , Barman Ananya , Sarkar Purabi , Gang Sneha
Published: February 2024

Context:

Cardiometabolic risk factors play crucial roles in left ventricular dysfunctions (left ventricular failure): a defining feature of heart failure (HF) with preserved ejection fractions (HFpEF). Among the many, serum uric acid (SUA) is a controversial risk factor that needs to be investigated globally.

Aim:

We aim to elucidate a correlation of SUA with ejection fraction percentage (EF%) in patients with chronic HF supporting the probable notion of hyperuricemia being a prognostic biomarker.

Settings and Design:

This retrospective, cohort study was performed on patients who visited from January 2022 to June 2022 in the Department of Cardiology at a tertiary care hospital in Northeastern India.

Methods:

A series of 81 selected patients with known congestive HF were documented with various baseline, clinical, and biochemical parameters. Patients were divided into three groups based on EF% and their relation with SUA, along with other parameters was analyzed.

Statistical Analysis:

Data were presented as mean ± standard deviation and frequencies for continuous variables and categorical variables, respectively. ANOVA one-way tests were conducted for continuous variables and CHI-square tests for categorical variables. P < 0.05 was considered as statistically significant.

Results:

A significant correlation was established between levels of SUA and EF (P = 0.021). Hence, hyperuricemia is directly related to an increased risk of lower EF.

Conclusion:

Even when asymptomatic, SUA can be used as a prognostic biomarker in the assessment of HF diseases.
Stent retrieval from renal artery by wire twist technique
Authors: Mukhopadhyay Tanmay , Roy Rammohan
Published: February 2024

Wire twist technique is an important technique for retrieval of dislodged stent or broken coronary wire in areas where snare cannot be negotiated because of its bulky profile. In our patient dislodged coronary stent had been successfully retrieved from renal artery using twist wire technique. A 59 years gentleman, diabetic, hypertensive and smoker admitted with recent anterior wall myocardial infarction and ongoing chest pain. On coronary angiogram patient had approx. 80% stenosis in proximal LAD and approx. 80% stenosis in large OM1. PCI to LAD done with a 3X24 DES placed from ostium of LAD. But balloon dilation of OM lesion was difficult because of its tortuosity and also a 3X33 stent couldn’t be negotiated . During removal of stent balloon came out and the stent was struck and hanging in the LCX to LM to Aorta. It spontaneously dislodged from coronary artery and entered right renal artery. However PCI to OM done with a smaller stent of 3X28 DES. A snare had been tried but couldn’t be negotiated through the renal artery using right femoral route and JR(5F) guide cath. As an alternative approach three coronary wires had been passed through the side of the dislodged stent and multiple twisting done through a torquer. Thus the stent was entangled with the wires and the whole system was pulled and removed.
Assessment of neurodevelopmental status using Development Assessment Scale for Indian Infants in children 6-24 months of age with congenital heart disease
Authors: Saini Jyoti , Lazarus Monica , Jain Pradeep Kumar , Bamne Pratibha
Published: February 2024

Context:

With improved awareness, early screening and diagnosis, and better postoperative care, the survival rate and life expectancy of congenital heart disease (CHD) population is on rise, and hence there is the uttermost need to study morbidities like neurodevelopment delay, which significantly affect quality of life in long term.

Aim:

Assessment of Neurodevelopmental Status Using Development Assessment Scale for Indian Infants (DASII) in children 6-24 months of age with CHD.

Settings and Design:

This was a descriptive, cross-sectional, hospital-based study, conducted in a tertiary care hospital of Central India.

Subjects and Methods:

The study included children 6–24 months of age with CHD confirmed by echocardiography. Their mental development quotient (DMeQ) and motor development quotient (DMoQ) was calculated using DASII. Developmental delay is defined as DQ <70% (<2 standard deviation) in either mental or motor domain.

Statistical Analysis Used:

Data entered in Excel spreadsheets and analyzed using SPSS 25.0.

Results:

Motor delay was found in 28% children and 26% children had mental delay (P = 0.0001). Among children with cyanotic CHD, both motor and mental development was seen in 80%, while in children with acyanotic CHD 18.8% children had motor delay and 16.5% children had mental delay (P = 0.0001). The mean DMoQ and mean DMeQ was significantly lower in the cyanotic group than in acyanotic group. The mean DMoQ and mean DMeQ was found to be significantly lower in the children with severe disease as compared to children with mild disease, as well as in the high-risk group as compared to low-risk group (P = 0.0001).

Conclusions:

We found high rates of motor and mental delay in children with cyanotic CHD, severe cardiac lesions, and high-risk category groups. Still, there is a need to find other associated factors, which can contribute to developmental delay, identified at the time of diagnosis through appropriate screening methods. Routine follow-up of these high-risk children with neurodevelopment assessment using DASII scale and early intervention will allow maximum growth and development of pediatric population with CHD and will have a positive impact on their quality of life.
Telemedicine is here to Stay: Success and Utility of Video Consultations in Neonatology
Authors: Bhat Zubair Ahmad , Gracy Nithya Babu , Pournami Femitha , Prabhakar Jyothi , Prithvi Ajai Kumar , Kolisambeevi Arif Abdulsalam , Jain Naveen
Published: February 2024

Background and Objectives:

“Synchronous videoconference telemedicine in neonatal office-practice” (SyNTOP) has been a routine practice in our center since the start of the COVID-19-related lockdown. We recently reported our experience with the “success” of this practice in terms of removing the need to visit the hospital over the next 48 h after the teleconsult.

Methods:

Secondary results of this retrospective descriptive study which analyzed 829 consults are presented in this manuscript. Data from electronic medical records of those who availed teleconsultation facility between March 2020 and April 2021 were retrieved. Relevant information about clinical presentation, findings from the video call, demographic information, decisions made by the clinician, and outcomes were collected. Best efforts were made to obtain follow-up information by the clinical team or guest–patient relations officers.

Results:

Fever (n = 118) and acute diarrheal disease (n = 58) were the common presenting complaints; most (80.5% and 95.5%, respectively) were resolved without physical examination; 265 developmental assessments were completed by video-facilitated checks. Fast-track vaccination visits where queries were resolved and bills paid online, were an innovation where well babies could avoid queues and possible exposure to crowds. One-fourths of SyNTOP were from outside the district, and 1.4% were from foreign countries.

Conclusions:

Teleconsults were successfully conducted in neonatal office practice for different health-care enquiries. Strategies such as fast-track vaccinations and online developmental follow-up assessments were performed by leveraging technology. We highlight the benefits of these innovations in our center with a view to enhance their uptake elsewhere. Such approaches have the potential to increase health equity and access to specialty health care.
Consequences of Changing Lifestyle amongst Indian Millennials on Procreation: An Overview
Authors: Raj Pallvi , Bhardwaj Geeta , Podder Lily
Published: February 2024

Conventionally, the focus of childbirth-related policies of the Government of India and other non-governmental organisations had been to mitigate teenage pregnancies and child marriage since being of tender age, they are most susceptible to mishaps. This problem has been adequately addressed at present and efforts are on-going in this direction. However, India’s blue-collared corporate workforce is rapidly growing in the age of information technology. Stressed working environment with long work hours for the pressure of completing deadlines, millions of young Indian millennial professionals are heading towards a life full of ailments and health issues and concerns The social, mental and health issues of the Indian millennial have been ignored or rather overseen by the Government, as well as Social Organisations mainly because of them being relatively better in the economic front. The focus of the present article is on late marriage, geriatric pregnancy and related health issues of the Indian millennial and its relevant impact on procreation complication.
Effectiveness of Squeezing Ball Technique on Reduction of Pain during Insertion of Intravenous Cannulation amongst Hospitalised Toddlers in a Selected Hospital, Kolar
Authors: Beneta V.
Published: February 2024

Background:

The hospitalised children undergo painful procedures during their treatment, like intravenous (IV) cannulation, leading to significant stress and discomfort. Accurate assessment and management of pain in children are vital in promoting comfort during hospitalisation. Psychological interventions like distraction techniques have been shown to be useful in reducing pain intensity.

Aim:

The objectives of the study were to evaluate the effectiveness of the squeezing ball technique in the reduction of pain during IV cannulation amongst hospitalised toddlers in experimental and control groups using the FLACC pain scale and to determine the association of pain score amongst hospitalised toddlers with selected demographical variables in experimental and control groups.

Methods:

A true experimental post-test-only design was adopted. Using the systematic random selection sampling (block number randomisation) technique, 60 hospitalised toddlers aged between 1 and 3 years undergoing IV cannulation, 30 in the intervention group and 30 in the control group, were included in the study. The pain was assessed using the FLACC pain rating scale.

Results:

The result showed that there was a significant decrease in the mean pain score of hospitalised toddlers in the experimental group (pain score = 8.26 ± 1.22) compared to the control group (pain score = 9.0 ± 0.87) during IV cannulation. There was no association between the sociodemographic variables and pain scores of hospitalised toddlers.

Conclusion:

The study reveals that the squeezing ball technique is effective in reducing pain amongst hospitalised toddlers admitted to the children’s ward.
Neonatal Mastauxe – Case Report
Authors: Dayal Era Deepika
Published: February 2024

Neonatal mastauxe is a fairly common condition of enlarged breasts in neonates. It is often incorrectly called ‘mastitis neonatorum’. Falling levels of oestrogen after birth are thought to stimulate prolactin secretion which in turn promotes the hypertrophy of breast tissue. Undue manipulation of enlarged neonate’s breasts, a common practice in Indian culture, may complicate the condition, even mandating surgery. The role of nurses in counselling and teaching the family in such cases is important. This case report presents a baby born by lower segment caesarean section in our unit with neonatal mastauxe.
Electrocardiogram Series: Normal Electrocardiogram and Arrhythmia
Authors: James Rintu Tisho , Mahalakshmi  , Chellaiyan Anbarasi , Roshan John , Rhenius Roselin
Published: February 2024

An electrocardiogram (ECG) represents the electrical activity of the cardiac cells. The ECG serves as a significant diagnostic test, especially in identifying and managing life-threatening arrhythmias and acute coronary syndrome. With the upsurge of non-communicable diseases, there is a significant increase in heart diseases, especially acute coronary syndrome and arrhythmias. Interpretation of ECG is a skill demanded of nurses irrespective of the healthcare settings for immediate intervention towards enhancing the positive outcome of patients. This article details the simplified interpretation of normal and abnormal ECGs towards updating one’s skill in ECG interpretation.
Capacity Building Programme on Diagnostic and Interventional Cardiology for Registered Nurses through Virtual Mode – Society of Cardiac Nurses-Extension for Community Healthcare Outcomes Collaborative Model
Authors: Raj L Suja , Swarnkar Neeraj Kumar , Thomas Dainy , Jyotishana K.P , Kankarwal Monika
Published: February 2024

Background:

Incorporating virtual modes of continuing education programmes for registered nurses enable their professional development as it overcomes the twin barriers of lack of time and geographical isolation.

Methods:

A course on the Diagnostic and Interventional Cardiology-Capacity Building Programme for nurses was planned and implemented amongst registered nurses in India by the Society of Cardiac Nurses and Project Extension for Community Healthcare Outcomes (SOCN-ECHO) collaborative model. The course curriculum included eight modules, and each module was taken once a week as a 2-h session. It consisted of comprehensive sessions dealt with by subject matter experts, case presentations and case discussions. In this study, 52 registered nurses from all over India were enrolled. The mean pre-test and post-test scores were calculated, and a paired t-test was used for statistical significance. The Chi-square test was used to determine the association between knowledge improvement and the characteristics of participants.

Results:

The mean age of the participants was 39.2 ± 8.36 years. Females constituted 92% of the participants. The mean year of experience was 12.4 ± 8.18. There was a significant difference between the mean pre-test (13.62 ± 4.52) and the mean post-test scores (19.38 ± 4.19, P < 0.001). Increased duration of experience as a professional nurse showed a significant association with good improvement in post-test scores (P = 0.01).

Conclusion:

Collaborative education model between professional organisations such as SOCN and Project ECHO was found to be effective in increasing the competency of nurses in specific areas of practice.
Non-pharmacological Intervention Approaches for Common Symptoms in Advanced Chronic Kidney Disease Patients on Haemodialysis: Narrative Review
Authors: Chowdhury Gulshan Roy , Kumar Yogesh
Published: February 2024

Background:

Patients with advanced chronic kidney disease (CKD) experience many bothersome symptoms, affecting their quality of life (QoL). The majority of these patients do not have the opportunity to receive a kidney transplant and need other treatments for these burdensome symptoms to improve their QoL and prognosis. With growing attention to the significance of symptom management in advanced CKD on haemodialysis (HD), the evidence regarding symptoms is increasing.

Methods:

In this review, we briefly summarise the current evidence of non-pharmacologic interventions to improve symptoms and QoL in patients with advanced CKD, on dialysis. Hence, we focused on symptoms that are commonly experienced by patients, such as pain, fatigue, sleep disturbances, itching, nausea and vomiting, cognitive impairment and anxiety and depression.

Results:

We noted that research on improving symptom management in CKD is still very limited. In addition to the lack of clinical practice guidelines to address those common symptoms, the evidence to how to incorporate effective symptom intervention approaches into clinical care is also rare.

Conclusion:

Although improving mortality remains an important area in the kidney community, there is an urgent need to focus on improving symptommanagement to improve QoL in advanced CKD on HD.
New onset gender dysphoria in bipolar affective disorder - A case series
Authors: Zahoor Bushra , Bhardwaj Akansha , Sharma Anjali , Raut Nitin , Kataria Dinesh
Published: February 2024

Gender confusion in the context of mania is very less frequently described in the literature. The actuality of a primary psychiatric condition in gender identity complaint has significant bearing on the applicable operation and prognostic. This case series describes cases of bipolar affective complaint presenting in a manic occasion whose mania was marked by hypersexuality and the desire to be of opposite gender. Both of these symptoms resolved with treatment of the manic occasion. Case 1 describes a 17-year-old male presenting with an episodic illness, with current manic episode. He is currently interested in boys and has started enjoying feminine activities. Upon treatment, his symptoms showed improvement. Case 2 describes a 22-year-old gay male, with a total duration of 7 years, current episode mania. Now, he is considering himself a lesbian and feels he is mentally a modern female. After 4 months of treatment, there was significant improvement in his complaints and he stopped cross-dressing as a female. Case 3 shows a 21-year-old female, with manic episode. After 1 month, the patient began acting and speaking more like a boy. The patient has shown improvement while taking lithium 900 mg, divalproex sodium 1000 mg, risperidone 6 mg, and chlorpromazine 150 mg. Gender dysphoria occurring along with a psychotic episode and resolving with management of the primary psychiatric disorder are rarely recorded. The central issue in similar cases is a proper workup and diagnosis. Psychiatrists should be aware of this scenario so that proper treatment strategies for gender incongruence can be planned and not be brushed aside as “just another symptom.”
Violence against women during pregnancy and its dimensions in COVID-19 pandemic: A systematic review and meta-analysis
Authors: Aghababaei Soodabeh , Masoumi Zahra , Tahmasebi Reza , Jenabi Ensiyeh , Toosi Zahra , Ghelichkhani Samereh
Published: February 2024

This systematic review and meta-analysis investigated the prevalence of violence against pregnant women during COVID-19 pandemic based on the available evidence. Medline, Scopus, Web of Science, and Google Scholar were searched. All published observational articles from December 2019 to December 2022 were assessed by two independent authors using the “violence, pregnancy, COVID-19” keywords. The quality appraisal of primary studies conducted using the Newcastle - Ottawa Quality Assessment Scale checklist and 10 eligible articles were included in this review. After reviewing the articles, the prevalence of violence among pregnant women during the COVID-19 pandemic was estimated to be 23% [95% confidence interval (CI) =18 to 29%] using the random effect model. Of them, 59% (95% CI = 13 to 105%) was attributed to verbal-behavioral violence, 30% (95% CI = 17 to 42%) emotional violence, 14% (95% CI = 8 to 20%) sexual violence, and 11% physical violence (95% CI = 6 to 17%). The results indicated that the violence prevalence among pregnant women was not different during and before the start of the COVID-19 pandemic. However, the behavioral-verbal, emotional, physical, and sexual violence were the most common forms of violence.
Uniqueness of auditory hallucinations in patients with schizophrenia and depressive disorder
Authors: Ali Tahoora , Kumar Santosh , Chaudhary Bhushan , Chaudhury Suprakash , Verma Pankaj Kumar
Published: February 2024

Background:

While over three-quarters of those suffering from schizophrenia and schizophrenia-like illnesses experience auditory hallucinations, 6% of individuals with depressive disorder report the same. Differentiating between auditory hallucinations in these two illnesses is important both diagnostically and prognostically.

Aim:

To compare the characteristics of auditory hallucinations in patients with schizophrenia and depressive disorder.

Materials and Methods:

For both schizophrenia and depressive disorder, 110 patients were selected from inpatients of a tertiary care psychiatric center by purposive sampling. They were assessed with a specially designed proforma containing sociodemographic information, information about clinical features, and characteristics of the Auditory Hallucination Scale.

Results:

Schizophrenia and depressive disorder patients were matched on age, education, occupation, and socioeconomic status. The patients with schizophrenia rated significantly higher on frequency, clarity, tone, intensity, distractibility, self-control, and distress dimensions of auditory hallucinations as compared to patients with depressive disorder.

Conclusion:

The characteristics of auditory hallucinations in schizophrenia differ significantly than those in depressive disorder, which bears significant transdiagnostic importance. Clinical evaluation of these differentiating characteristics of auditory hallucinations may aid in diagnostic workup in patients.
Tensor Ring Based Image Enhancement
Authors: Sedighin Farnaz
Published: February 2024

Background:

Image enhancement, including image de-noising, super-resolution, registration, reconstruction, in-painting, and so on, is an important issue in different research areas. Different methods which have been exploited for image analysis were mostly based on matrix or low order analysis. However, recent researches show the superior power of tensor-based methods for image enhancement.

Method:

In this article, a new method for image super-resolution using Tensor Ring decomposition has been proposed. The proposed image super-resolution technique has been derived for the super-resolution of low resolution and noisy images. The new approach is based on a modification and extension of previous tensor-based approaches used for super-resolution of datasets. In this method, a weighted combination of the original and the resulting image of the previous stage has been computed and used to provide a new input to the algorithm.

Result:

This enables the method to do the super-resolution and de-noising simultaneously.

Conclusion:

Simulation results show the effectiveness of the proposed approach, especially in highly noisy situations.
Tumor resection in stages as a strategy for approaching giant intracranial tumors in childhood
Authors: Furtado Leopoldo Mandic Ferreira , da Costa Val Filho José Aloysio , Sandes Bruno Lacerda , Rodrigues da Costa Gustavo Alberto , Machado Filho Guaracy de Macedo , Alencar Maciel Fernando Levi
Published: February 2024

Abstract

Background:

Giant pediatric intracranial tumors (GPIT) are associated with high morbidity and mortality and pose a challenge for treatment. This study evaluated the morbimortality-related outcomes of staged resection of GPIT. An observational study was undertaken.

Materials and Methods:

Twenty children with GPIT were retrospectively evaluated for demographics, clinical presentation, histopathology, weight at first intervention, hemotransfusion rate, weight gain between stages, complications, and survival factors. Non-parametric tests were performed owing to the sample size. The significance level adopted was 5% with a 95% confidence interval.

Results:

The average age was 3 years and 11 months. Fourteen (70%) patients had tumors in the supratentorial compartment. Thirty-seven interventions were performed with an average weight gain of 1.7 kg between the stages. The most frequent histological types were choroid plexus carcinomas (3), medulloblastomas (3), atypical rhabdoid teratoid tumor (2), and ganglioglioma (2). The mean blood transfusion rate was 28.4 mg/kg. The mean follow-up duration was 19.8 months (range: 1–68 months).

Conclusion:

The treatment strategy of resecting GPIT in stages proved to be effective in minimizing bleeding, obtaining maximum safe resection, and enabling the patient to recover between procedures. Notably, the degree of malignancy remains the most limiting factor in the survival of these patients.
Intramedullary spinal cord abscess—rare complication of a congenital dermal sinus: Report of a case in a toddler
Authors: Prasad G Lakshmi
Published: February 2024

Abstract

Lumbosacral region is the commonest location for a dermal sinus (DS). The DS provides a natural pathway for infections of the deeper tissues such as the meninges or spinal cord, depending on its termination. One of the rarest and serious complications of a DS is an intramedullary spinal cord abscess. One such case has been reported here. A 2-year boy presented with high-grade fever, acute onset flaccid paraplegia and urinary retention. A L5 level DS was noted. Imaging showed a D12-L5 heterogeneously enhancing intradural lesion suggestive of an abscess. Multi-level laminectomy and drainage of abscess with removal of an inclusion epidermoid was performed. Complete recovery of all neurological functions was achieved that remained stable at 60 months follow up.
Spectrum of cortical malformations on fetal MRI: A pictorial essay
Authors: Rajamani Logesh , Rangasami Rajeswaran , Chandrasekharan Anupama , Suresh Indrani , Suresh Sudarshan
Published: February 2024

Abstract

The aim of this article was to illustrate the major stages in cerebral cortical development, review the spectrum of cortical malformations based on the affected developmental stage, describe the characteristics of the major cortical malformations that may be diagnosed prenatally on fetal magnetic resonance imaging (MRI), and to understand the limitations of fetal MRI. Fetal MRI may show large dysmorphic cortex in hemimegalencephaly, cortical tubers, and subependymal nodules in tuberous sclerosis, smooth featureless cortex in classic lissencephaly, bumpy cortex in cobblestone lissencephaly, ectopic gray matter in heterotopia, excessive microgyri in polymicrogyria, and transmantle cerebral clefts in schizencephaly. We conclude that fetal MRI is of major value in diagnosing many of the cortical malformations including those suspected on prenatal ultrasound. However, fetal MRI is of limited sensitivity in detecting few cortical abnormalities like microdysgenesis especially in the second trimester, as gyration continues to evolve during late pregnancy and even after birth.
Acute symptomatic seizures due to metabolic derangements in pediatrics
Authors: Cornelius Leema P , Elango Neeraj , Kuttavajeyaram Venkateswaran
Published: February 2024

Abstract

Background:

Seizures due to an underlying metabolic abnormality form an important subset of acute symptomatic seizures in that they are treatable and do not require long-term anticonvulsants. The objective of this study is to determine the clinical and etiological profile of children with metabolic seizures.

Materials and Methods:

A prospective observational study done in children admitted with acute symptomatic seizures who had an underlying metabolic abnormality as the cause of seizures from January 2018 to December 2019 in a tertiary care hospital of South India. Demographic and clinical parameters were noted and relevant investigations including biochemical, neuro imaging, cerebro spinal fluid analysis, electro encephalography were carried out accordingly.

Results:

Among 1256 children admitted with new onset seizures, 408 (32.5%) had acute symptomatic seizures exclusive of febrile seizures and unprovoked seizures, of which 46 (3.7%) were found to have an underlying metabolic abnormality and were analyzed. The ratio of male to female was 1.4:1 and the peak age was infancy, accounting for 62.5%. The leading causes of metabolic seizures included hypocalcemia in 28 (60.9%), hypoglycemia in 16 (34.8%), and hyponatremia in 2 (4.3%). Vitamin D deficiency in 21(75%) was found to be the commonest cause for hypocalcemia, followed by hypomagnesemia, hypoparathyroidism, osteopetrosis, and renal failure. The various causes of hypoglycemia were Addisons disease in 6(37.5%), hyperinsulinemic hypoglycemia, idiopathic ketotic hypoglycemia, glycogen storage disorder, and fatty acid oxidation defect, congenital adrenal hyperplasia, and Laron syndrome. Both children with hyponatremia were diagnosed as congenital adrenal hyperplasia.

Conclusion:

Metabolic seizures accounted for 3.7% of new onset seizures and 11.3% of acute symptomatic seizures in our study. Hypocalcemia (60.9%) was found to be the commonest cause of metabolic seizures in children with the majority due to vitamin D deficiency (75%). Addison’s disease (37.5%) was found to be the common cause for hypoglycemia. It is reasonable to estimate serum calcium, magnesium, electrolytes, and glucose in all children presenting with new onset seizures.
A study on neurosonography in neonates with hypoxic–ischemic encephalopathy and its correlation with neurodevelopmental outcome
Authors: Mangaraj Nachiketa , Sarangi Pradosh Kumar , Malhotra Vinita , Javed Arij
Published: February 2024

Abstract

Background:

Hypoxic–ischemic encephalopathy (HIE) is a devastating condition causing severe neurologic deficits and deaths in children, occurring in about 1.5 out of 1000 live births. The pattern of brain injury depends on the severity and duration of hypoxia as well as the degree of brain maturation at the time of insult. The prognosis can depend largely on diagnosing the early screening of suspected cases, assessment of severity of the injury, and timely intervention.

Aims and Objectives:

This study is aimed at signifying the importance of neurosonography in neonates with HIE as a diagnostic tool and screening modality in the neonatal intensive care unit (NICU) and at establishing the role of neurosonography and Doppler sonography as an investigatory modality for predicting the neurological damage and influencing their neurodevelopmental outcome.

Design:

This is a prospective longitudinal-type study.

Materials and Methods:

A total of 50 neonates admitted in the NICU were included in the study from January 2017 to August 2018 with FUJIFILM SONOSITE (Bothell, Washington, USA) machine using a high-frequency linear probe (6–12 MHz) and convex probe (2–5 MHz). A total of 50 neonates admitted to the NICU were selected and enrolled in the study after fulfilling the selection criteria. The first scans were obtained within 72 h of birth, and subsequent follow-up scans were done between the 8th and 10th day and on the 30th day. The infants were then followed up after 6 to 12 months for a detailed neurological assessment.

Statistical Analysis Used:

All the statistical analyses were carried out using Fisher’s exact test.

Results:

Out of the eight neurosonographic (NSG) findings analyzed in our study that were found to be associated with hypoxemic brain changes, four of them showed a statistically significant correlation with high positive predictive value (PPV) with poor clinical outcome at 6 to 12 months of age. The PPV of neonates with ventriculomegaly, multicystic leukomalacia, abnormal Doppler indices, and intraventricular hemorrhage (IVH) was found to be 78%, 80%, 82%, and 87%, respectively.

Conclusions:

Neurosonography was found to be highly significant to predict the clinical outcome in neonates with HIE, and it should be used as the initial screening modality.
A study of second trimester fetal neuroanatomy based on cadaveric dissection technique
Authors: Jain Sonal A , Nadkarni Trimurti D
Published: February 2024

Abstract

Background:

The knowledge of fetal neuroanatomy is essential to advance fetal neurosurgery and the management of preterm neonates.

Aims:

The aim of the present study was to establish second trimester fetal neuroanatomy normative data.

Materials and Methods:

We studied 13 cadaveric fetal specimens of gestational age (GA) 16–20 weeks by observation and the dissection technique. The absolute and standardized dimensions of various fetal cranial structures were noted.

Results:

There were four female and nine male second trimester cadaveric fetal specimens. The crown rump length (CRL) and biparietal diameter (BPD) were measured. The GA ranged from 16.48 to 21.16 weeks, as estimated from the BPD. The range and average values for absolute and standardized dimensions of various fetal cranial structures such as the cerebral hemispheres, skull base, the ventricular system, cerebellum, hippocampus, and caudate nucleus were studied. The effect of shrinkage due to formalin fixation was considered.

Conclusion:

The characterization of second trimester fetal neuroanatomy by the cadaveric dissection technique is feasible. Fetal structures related to the paleocortex are well formed at this stage. The temporality of the emergence of fetal brain sulci is a viable predictor of GA.
Endoscopic Management of Internal Laryngopyocele Presenting with Acute Airway Obstruction
Authors: Anand V. , Anand Aishwarya , Anjaly R.
Published: February 2024

A laryngocele is an abnormal dilatation of the laryngeal saccule. It is asymptomatic most of the time, so its true incidence is unknown. Depending on the site, symptoms can arise. Radiologic confirmation of diagnosis is a must. A 50-year-old diabetic man presenting with acute airway obstruction was evaluated and found to have an internal laryngopyocele which was managed with intravenous antibiotics and endoscopic approach (draining and marsupialisation) after securing the airway with a tracheostomy. A review of the literature reveals that there is no consensus to manage such patients due to the rarity of the problem. The patient was decannulated in 5 days and made a good recovery. We advocate an endoscopic approach for internal laryngopyocele in emergencies as it can expedite recovery due to less morbidity when compared to an external approach.
A Comparative Study of Modified Alvarado Scoring and Raja Isteri Pengiran Anak Saleha Appendicitis Scoring Systems for the Diagnosis of Acute Appendicitis
Authors: Siva A. , Abraham Santhosh John , Iype Vimal
Published: February 2024

Background:

Acute appendicitis is one of the most common surgical emergencies, with a lifetime prevalence rate of approximately one in seven. There have been various scoring systems developed, of which Alvarado and modified Alvarado scores have been used commonly, but both have low diagnostic value when used in Middle Eastern and Asian populations. Different techniques have been devised to assist in equivocal cases in attempts to decrease negative appendicectomy rates. In the present study, Modified Alvarado Scoring System (MASS) and Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) are compared amongst the local population in Kerala, to find out which scoring system is more relevant and applicable, in order to aid early diagnosis of acute appendicitis.

Materials and Methods:

This is a prospective study which included 125 patients for a period of 13 months from November 2020 to December 2021.

Results:

The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of MASS score were 62.11%, 60.00%, 83.10% and 33.33%, respectively. The sensitivity, specificity, PPV and NPV of RIPASA score were 90.53%, 76.67%, 92.47% and 71.88%, respectively. The diagnostic accuracy of MASS and RIPASA scoring systems was 61.6% and 87.2%, respectively. The results indicate that RIPASA scoring system is a better diagnostic tool for diagnosing acute appendicitis.

Conclusions:

Based on this study, RIPASA scoring system is more accurate and specific than MASS in diagnosing acute appendicitis.
Severe Acute Epididymo-orchitis Complicated with Testicular Necrosis
Authors: Mittal Mohit , Gaur Nimish , Singh Shalendra , Gupta Nipun , Singh S. Ushakiran
Published: February 2024

Acute epididymo-orchitis (EO) (the inflammation of one or both testes and epidermis) is an emergency condition that usually responds to conservative management and is diagnosed based on symptoms and clinical examination. The diagnosis is usually established based on clinical symptoms and physical examination, but also further examinations could be helpful in confirming the EO diagnosis and in identifying complications. Differentiation between EO and testicular torsion can sometimes be difficult. Colour Doppler ultrasound (CDUS) is a useful tool to assess the vascularity of testicular tissue before surgical exploration of the testis. We present a case of acute EO complicated with testicular necrosis to highlight the importance of CDUS in cases not improving with conservative management.
Changing Dynamics of Self-Harm by Attempted Suicidal Hanging during the COVID-19 Pandemic
Authors: Nair Shalini , Selwyn Tryphena , Varghese Mammen P. , Karuppusami Reka , Aaron Sanjith
Published: February 2024

ABSTRACT

Background:

The second wave of coronavirus disease (COVID-19) in 2021 was devastating for low- and middle-income countries (LMICs). This led to increased suicide rates among the young, economically productive age group. We analyzed the cohort of attempted suicidal hangings needing admission to the intensive care unit (ICU) and compared the data from the pre-COVID-19 era.

Materials and Methods:

We conducted a retrospective, observational, cohort study of suicidal hanging cases according to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Six-month data of such cases admitted to the neurological ICU after the lockdown of the second wave of COVID-19 from July 2021 to January 2022 were collected. Demographic data along with the cause of attempted hanging, severity of sickness from hanging, and its outcome were gathered and compared with similar data acquired during 2003–2015 by the same authors in the same ICU.

Results:

There was a threefold increase in the incidence of suicidal hangings needing ICU care, from 9 to 27% in the pre- and post-COVID-19 era. A shift toward older aged males, in the third decade of life, was observed. The common cause of attempted suicide was a familial dispute (P = 0.03). Among the younger age group (18–25 years), increased screen time led to fights in the family. The cohort was also sicker with more severe lung involvement, longer ventilation, and hospital stay (P < 0.001).

Conclusion:

The increased incidence of hanging among young adults, amid the socioeconomic effects of COVID-19, needs urgent attention. Suicide prevention measures need novel strategies aimed at de-addiction from electronic gadgets and reducing screen time.
Does Transcutaneous Electrical Nerve Stimulation (TENS) along with Jacobson’s Progressive Relaxation Technique Influence Dysfunctional Breathing in Individuals with Chronic Neck Pain?
Authors: Deshmukh Mayura P. , Gopiyani Ishani , Baxi Gaurang , Palekar Tushar J. , Pokle Siddhi
Published: February 2024

ABSTRACT

Background:

Amongst all musculoskeletal problems, chronic neck pain has a high prevalence and impacts an individual’s wellbeing and quality of life. Due to chronic neck pain, many changes occur which can prompt biomechanical changes in the dorsal/thoracic spine and hence on respiratory muscle work. There is a close bidirectional relationship between pain and the autonomic nervous system. Chronic pain bringing about permanent up gradation of the autonomic nervous system prompts modifications in vital parameters, which in turn if persists results in dysfunctional breathing.

Methodology:

30 chronic neck pain people were selected to determine the immediate effect of transcutaneous electrical nerve stimulation and Jacobson’s relaxation technique in individuals with chronic neck pain. Prepost intervention assessment for pain and dysfunctional breathing were compared and analyzed using paired ttest and Wilcoxon rank sum test.

Result:

For pain, the mean difference (−2.23) was statistically significant (P < 0.001) whereas the breath hold test at total lung capacity and functional residual capacity showed mean differences (7.40) and (−6.83), respectively which were both statistically significant (P < 0.001).

Conclusion:

TENS along with Jacobson’s Progressive Relaxation Technique helps to reduce pain and correct dysfunctional breathing in individuals with chronic neck pain.
Effectiveness of PEEP and Recruitment Maneuvers in Improving Oxygenation in Laparoscopic Hysterectomies: A Randomized Controlled Trial
Authors: Gayathri Balasubramaniam , John K Joy , Ramani CK Swetha
Published: February 2024

ABSTRACT

Rationale:

To determine whether positive end-expiratory pressure (PEEP) with lung recruitment will benefit in improving oxygenation and in reduction of post-operative complications in patients undergoing gynecological laparoscopic surgeries in Trendelenburg position.

Methods:

Seventy-two patients, 36 in each arm, were recruited for single blind randomized controlled trial. Patients in intervention arm received a PEEP of 8 cm H2O and lung recruitment every 45 min and at the end of surgery. Patients in non-intervention arm (group N) received conventional ventilation with no PEEP and recruitment maneuver. Analysis was done on the basis of PaO2, intraoperative hemodynamics, and post-operative complications.

Results:

Intra-operative pH, pO2, and pCO2 values were 7.41 ± 0.03; 193.8 ± 13.4; and 38.6 ± 2.6 mmHg in group P, and 7.39 ± 0.72; 162.1 ± 5.3; and 38.8 ± 2 mmHg in group N. A significant increase in pO2 level was noted in the PEEP with recruitment group. Post-operative pH, pO2, and pCO2 values in group P were 7.33 ± 0.03; 87.5 ± 4; and 37.2 ± 3.1 mmHg, respectively, in group P and 7.32 ± 0.03, 87.8 ± 2.7; and 38.5 ± 2.6 mmHg in group N. No significant difference in the arterial blood gas (ABG) values was noted in both the groups in the post-operative period. We did not notice any significant hemodynamic variation in the intervention group (group P) checked 1 min, 3 min, and 5 after performing after recruitment maneuver (RM).

Conclusion:

PEEP with RM can be used to improve oxygenation in patients undergoing laparoscopic surgeries in Trendelenburg position. It has no effect in improving post-operative oxygenation.
Bilateral Becker’s Nevus Over the Scalp: A Rare Encounter
Authors: Sane Renuka Roja , Chandrasekaran Balakumaran , Manoharan Krishnaswamy , Nagaraju Sowmya
Published: February 2024

ABSTRACT

Becker’s nevus is a cutaneous smooth muscle hamartoma characterized by a unilateral, hyperpigmented, and hypertrichotic patch that commonly affects the upper trunk. It most commonly presents during puberty and sometimes it may be present since birth. We, hereby, report a case of late onset bilateral Becker’s melanosis over the scalp which is an unusual site.
Impact of a New Module to Enhance the Learning of Ethical Principles in Students of Phase I MBBS Course
Authors: Chaudhuri Arunima , Ghosh Tapas , Saldanha Daniel
Published: February 2024

ABSTRACT

Background:

Healthcare decisions need to be based not only on clinical and technical grounds but also on ethical considerations.

Aims:

To develop a module for teaching ethics to newly admitted medical students and help medical students recognize the importance of being sensitive to ethical issues in daily clinical practice and develop the ability to address the ethical concerns of patients efficiently.

Methodology:

An interactive module was developed and introduced among first-phase MBBS students over a period of 4 weeks after taking institutional ethical clearance and informed consent of the participants.

Results:

Two hundred students of First Phase MBBS batch 2021-2022 participated in the study. Students performed significantly better in the post-test examination (mean ± standard deviation: 89.65 ± 4.9) as compared to the pretest examination (mean ± standard deviation: 49.34 ± 12.02); P value <.0001**. Students and faculty members were satisfied with the teaching-learning methodology implemented. In the one-month period of time, 48 students could complete the Good Clinical Practice course available at https://gcp.nidatraining.org/with more than 80% marks after appearing for 11 examinations and receiving certificates valid for three years.

Conclusions:

The present module on medical ethics introduced among first-phase MBBS students helped them to learn the core principles of ethics in medicine. It increased their critical thinking and problem-solving abilities.
Erector Spinae Block for Pain Relief in a Case of Rib Fracture
Authors: Nankar Yashwanth , Bagle Aparna , Pujari Spoorti , Nankar Archana
Published: February 2024

ABSTRACT

Uncontrolled pain in patients with rib fracture leads to atelectasis and impaired cough which can progress to pneumonia and respiratory failure necessitating mechanical ventilation. Of the various pain modalities, regional anesthesia (epidural and paravertebral) is better than systemic and oral analgesics. The erector spinae plane block (ESPB) is a new modality in the armamentarium for the management of pain in multiple rib fractures, which is safer to perform and better viewed under ultrasound guided. We report a case where ESPB helped provide pain relief to a rib fracture patient.
Shelf-Life Evaluation and Comparative High-Performance Thin-Layer Chromatography Profile of Amavatari rasa: A Preliminary Study
Authors: Bhinde Sonam Sagar , Patgiri B. J.
Published: February 2024

ABSTRACT

Background:

In addition to safety and efficacy data, it is important to establish quality parameters for all drugs, including shelf life. Shelf life is the length of time that a product may be stored without becoming unfit for use, consumption, or sale. Every product in this universe has a definite shelf life. In Ayurveda texts, shelf life is known as Saviryata avadhi that is defined as the time period during which the potency (Virya) of any drug remains unaffected. Amavatari
Rasa (AR) is an important formulation being used in Ayurvedic therapeutics; however, its shelf life is not reported till date.

Aims and Objectives:

This study aimed to evaluate shelf life of AR through accelerated stability study.

Materials and Methods:

Accelerated stability study and comparative high-performance thin-layer chromatography (HPTLC) profile were done to evaluate the shelf life of the AR. The formulation was prepared by using authentic raw material in the departmental laboratory by the following classical guidelines. It was evaluated by analyzing changes in physicochemical profiles of the product after keeping it at specific temperature (40°C ± 2°C) and relative humidity (75% ± 5%). Analysis was carried out at the intervals of 0, 3, and 6 months. Average 10% degradation time was calculated and extrapolated to find the shelf life as per the ICH guidelines.

Results and Conclusion:

In the present study, shelf life of AR was found to be 48 months; similar Rf values obtained in HPTLC analysis of AR initially and after 6 months showed the minimum deterioration of the product.
An Alternative Treatment Option for Congenital Syphilis: A Case Series
Authors: Shirolkar Mukund , Verneker Ruchika
Published: February 2024

ABSTRACT

Newborn babies born to untreated syphilis-positive mothers need to be treated adequately and timely to prevent and cure congenital syphilis. Penicillin is one of the most robust and the most recommended drug for the same. However, in case of penicillin shortage or an adverse effect to penicillin, an alternative treatment is warranted. Injection ceftriaxone is a promising drug in case of penicillin unavailability. We present a case series in which we treated five asymptomatic newborn babies having positive venereal disease research laboratory (VDRL) titers with ceftriaxone 100 mg/kg/day in two divided doses for 10 days. The patients were cured and discharged on Day 11.