bluuebunny/crossref_metadata_2025 huggingface dataset:
Organophosphorus poisoning: A retrospective study on clinical profile and outcomes in ICU
Authors: Nadia Rose  , Sowmya Madihalli Janardhan Iyengar  , Navaneethan NK  , Sarath Chandra B
Published: January 2025

Background: Organophosphorus (OP) compounds are widely used in India as insecticides and contribute to both acute and chronic poisoning. Several parameters have been analyzed to evaluate the severity of poisoning and to prognosticate the outcome but contradictory results have been obtained from studies for example for the relationship between hypokalemia and outcome, pseudocholinesterase (PChE) levels, and outcome.
Aims and Objectives: The objectives of this retrospective study were to explore the epidemiological characteristics and clinical profile of patients admitted to intensive care unit with OP poisoning and to evaluate the outcomes including complications, in hospital mortality, and the predictors of mortality.
Materials and Methods: All the patients above 18 years admitted with a history of ingestion of OP poisoning during the study period were included in the study. Data were collected from case records.
Results: The mean age of the patients was 34±13.54. Fifty-four patients were male (69.2%) and 24 were female (30.8%). The correlation coefficient between intubation and PChE levels was 0.266. The mean period of ventilation was 4.16 days±2.41 days. About 80% (n=20) put on ventilator survived. Correlation of hypokalemia with patients getting ventilator support was 0.26 and that with mortality was 0.038.
Conclusion: OP poisoning cases were primarily noted in the younger male group with the intent to self-harm. Chlorpyrifos was the most common compound consumed. Early admission and appropriate treatment can reduce mortality and complications as there is no single factor which can be used to predict the outcome in these patients.
Idiopathic intraosseous ganglion of the distal tibia in a young adult male: A case report with review of literature
Authors: Javed Ahmad  , Brijmohan Patel  , Ahmad Ayaz  , Vivek Kumar Shrivastava  , Mohit Kumar Singh
Published: January 2025

Intraosseous ganglion is a benign cystic bony lesion containing viscous and mucinous gelatinous material, which is usually seen in middle-aged individuals. It is similar to soft-tissue ganglion cysts present in other parts of the body. We, hereby, report a rare case of idiopathic intraosseous ganglion of the tibia in a young adult who presented with chronic pain in his lower leg. The patient was subjected to X-ray and MRI investigations and managed by excisional curettage of the lesion and histopathological examination. On histopathology, the diagnosis of intraosseous ganglion was confirmed. On 2-year follow-up, the patient was doing well without any complication and recurrence. This report describes the diagnosis and successful management of intraosseous ganglion at a very rare site in a young individual. More in-depth studies are required to understand the predisposing factors, underlying pathology, early diagnosis, and management of this lesion.
The perfect trio to decrease mortality in pancreatic cancers: Molecular marker screening tests with biosensors in precancerous lesions
Authors: Hasan Zafer Acar  , Nazmi Özer
Published: January 2025

The mortality rates of pancreatic cancer (PC) are very high. The methods recommended in the studies conducted to date have been able to reduce mortality very little. This study aimed to review studies on this subject and to identify the most appropriate methods to decrease mortality in PCs. Therefore, research articles and reviews on this subject were analyzed intensely, and the findings were summarized. According to the results obtained in our study, to decrease mortality in pancreatic ductal adenocarcinomas, early diagnostic screening should be performed primarily with molecular markers and biosensors effective in precancerous lesions in risk groups. However, studies on such screening worldwide have not yet been conducted. Therefore, further research is needed to arrive at more precise conclusions.
Case of triple extradural hematoma in a single patient: A rare case report
Authors: Jolly Sinha  , Avdhesh Shukla  , Vivek Kumar Kankane  , Avinash Sharma  , Sutradhar Sridham
Published: January 2025

Epidural hematoma (EDH) is found in 1–4% of traumatic brain injury cases. Acute triple extradural hematoma is a rare presentation of head trauma injury. In sporadic cases, they represent 0.5–1% of all extradural hematomas. Here is a case report of a 36-year-old female patient who presented to us with a head injury due to fall from a bike due to collision with a stray animal. The patient had a Glasgow Coma Scale of 9 (E2V2M5) with bilateral sluggishly reacting pupil to light. Computed tomography showed asymmetric bilateral posterior fossa EDHs along with an extradural hematoma in the right frontal region with multiple small contusions with mass effect. The surgical evacuation was performed first of the posterior fossa in the prone position and then right frontal hematoma evacuation in the supine position in the same sitting. The patient recovered well and was discharged on the 10th post-operative day with no neurological deficit. Early drainage of hematomas has been demonstrated to be an effective technique that soon decreases the intracranial pressure and promotes an efficient resolution to the neurological damage.
Knowledge, attitude, and practices of adolescent school girls regarding menstrual hygiene in Lucknow district
Authors: Ruby Khatoon  , Shahzeb Ansari  , Syed Abid Asghar  , Beena Sachan  , Zeashan H Zaidi  , Ahmad Sharique
Published: January 2025

Background: Girls’ adolescence has been recognized as a unique period that occurs as they cross the threshold from childhood to adulthood. Menstruation is typically viewed in Indian society as unclean. A negative attitude about this condition has been perpetuated by efforts to isolate and restrict menstruation females in the household. Numerous investigations have discovered restrictions in daily activities. On the other hand, maintaining good cleanliness habits during menstruation is important for reproductive health since it reduces vulnerability to infections of the reproductive tract.
Aims and Objectives: The aim of the study was to assess knowledge and attitude about menstrual health among adolescent girls in rural and urban schools in Lucknow district and to find out practices of menstrual hygiene among them.
Materials and Methods: The study unit consists of 410 teenage school-going females who live in both urban and rural regions of the Lucknow district. There was a multi-stage random sampling. A pre-developed and pre-tested interview schedule was employed toobtain data. Participants were questioned about their personal cleanliness, which need to be covered in the academic program.
Results: Four hundred and ten adolescent girls who were enrolled in school participated in the study. The majority of girls in this survey (52.8%) are between the ages of 17 and 19. 87.6% of the girls reported being ignorant of menstruation before menarche. While 41.6% of the girls were unaware of the organ from which bleeding originates, around 68.2% of the girls believed that the primary reason of menstruation is physiological and unrelated to any sickness. At the age of 10–13 years, 42.60% of the girls reached menarche. The majority of participants (60.80%) gave accurate responses to the question about the typical menstrual cycle’s average length. Only 35.27% of the girls were aware of the proper menarche age. Of them, 65.50% were aware of the issues with their reproductive health.
Conclusion: Lack of education among mothers and other female family members may contribute to girls’ lack of knowledge and awareness of menstruation. Misinformation, pre-conceptions, limitations, and a lack of knowledge around menstruation come in many different forms. As a result, when the entire family is familiar with the phenomena of menstruation, age-old prohibitions, conventional preconceptions, incorrect ideas, and negative attitudes may be successfully erased.
Spectrum of histopathological patterns of breast lesions in a tertiary care hospital
Authors: Akinapally Mrudula  , Mohd Imran Ali  , Swathi Samalla  , Rajarikam Nagarjuna Chary
Published: January 2025

Background: Breast lesions are areas of abnormal breast tissue. It is estimated that 20% of women develop breast lesions. Breast lesions are either benign or malignant. Breast carcinomas are the most common cause of deaths in women accounting for 10.6% deaths in India, 6.9% deaths per year globally.
Aims and Objectives: To study various histopathological patterns of breast lesions in women admitted in Government General Hospital.
Materials and Methods: It is a prospective study in the department of pathology, Government General Hospital, Nizamabad, from December 2020 to July 2022. Grossing was done and details noted, tissue bits were processed and sections were stained with conventional H and E Staining.
Results: Out of 70 cases of breast lesions, 55 (78.5%) are benign breast lesions and 15 (21.5%) are malignant breast lesions. Fibroadenoma is the most common breast lesion accounting for 33 cases, that is, 60 %, followed by fibrocystic diseases (21.8%). Infiltrating ductal carcinoma of No Special Type is the most common malignant breast lesion accounting for 10 cases, that is, 66.6%. Among invasive breast carcinomas, the majority of cases are Grade II (69%).
Conclusion: Study of histopathological patterns of breast lesions plays an important role in diagnosis, treatment, and prognosis of breast lesions. This study highlighted incidence and pathological characteristics of a wide range of breast lesions.
Multidetector computed tomography in evaluation of buccal mucosa cancer
Authors: Nikhilendra Reddy AVS  , Deepti Naik  , Anil Kumar Sakalecha  , Rajeswari G  , Yashas Ullas L  , Revanth RB  , Suryakanth Anne
Published: January 2025

Background: Squamous cell carcinoma is the most prevalent kind of tumor of the buccal mucosa. For the purpose of planning surgery and radiotherapy for tumors of the tongue, floor of the mouth, and oropharyx, imaging to locate the size and extent of the original tumor is essential. Therefore, it is beneficial to determine the radiation field, to ensure adequate tumor margin excision, and overall to improve the patient’s prognosis.
Aims and Objectives: The aim of the study was to evaluate the role of computed tomography (CT) scan in diagnosis of buccal mucosal malignancies and its characteristics.
Materials and Methods: Total 50 patients suspecting buccal mucosa cancer were referred to Radiology Department. They were subjected for CT scan examination on 16 slice CT scanner. CT scan evaluation was made for size and extent of primary mass lesion. The staging of disease was performed with TNM classification.
Results: In our study, out of 50 patients, the fourth decade (30%) and fifth decade (26%) saw the highest incidence of buccal mucosa cancer. The majority of the patients were suffering from severe disease; 44% had T4 stage and 58% had Stage IV.
Conclusion: CT plays a very important role in staging of buccal mucosa malignancy and effectively detects bone erosion (98% sensitive) and invasion to infratemporal fossa. However, during the early stages of cancer, a CT scan might not be very helpful.
Effect of addition of intrathecal preservative free magnesium sulfate with 0.5% bupivacaine heavy and fentanyl with 0.5% bupivacaine heavy on post-operative pain relief in patients undergoing hysterectomy
Authors: Ankita Gupta  , Neelima Tandon  , Namrata Jain  , Manmohan Jindal
Published: January 2025

Background: Spinal anesthesia is the most common neuraxial anesthesia for infraumblical surgeries. The use of various adjuvants has become popular in today’s scenario to enhance its quality.
Aims and Objectives: The aim of this study was to evaluate the onset, duration of sensory and motor block, hemodynamic effects (if any), duration of post-operative analgesia, and adverse effects of fentanyl or magnesium given intrathecally with 0.5% bupivacaine heavy in patients undergoing hysterectomy.
Materials and Methods: This prospective randomized double-blinded study was conducted in total sixty patients undergoing hysterectomy, divided into two groups of 30 patients each. Group F received 25 μg fentanyl with 3 mL 0.5% bupivacaine heavy and Group M received 100 mg magnesium sulfate with 3 mL 0.5% bupivacaine heavy. The onset and duration of sensory and motor blockade, duration of analgesia, hemodyamics, and side effects were assessed.
Results: The mean time of onset of sensory and motor block was less in fentanyl (P<0.001). Duration of sensory, motor block, and duration of analgesia was more in fentanyl group (P<0.001), whereas incidence of side effects such as bradycardia, hypotension, and shivering was less in magnesium.
Conclusion: Our study concluded that addition of fentanyl as adjuvant effectively augmented the quality of spinal anesthesia, but magnesium provided stable hemodynamics and lesser side effects as compared to fentanyl.
Comparative study between digital breast tomosynthesis plus digital mammography and digital mammography alone in symptomatic women using BI-RADS score
Authors: Syeed Aalishan Fatima  , Majid Jehangir  , Aijaz Ahmad Ganai  , Masrath Quyoom
Published: January 2025

Background: Digital mammography (DM) is the only screening modality that has been proven to reduce mortality from breast cancer through early detection. However, to reduce false positive results and improve the sensitivity of DM, we undertook a study to compare the impact of digital breast tomosynthesis (DBT) to DM in the evaluation of symptomatic women using the breast imaging reporting and data system (BIRADS) score.
Aims and Objectives: The aim of the study was to compare the impact of DBT to DM in the evaluation of symptomatic women using BIRADS score.
Materials and Methods: This cross-sectional study of 100 symptomatic patients in the age group of 35–85 years who underwent DM and DBT was included in the study and was analyzed using the American College of Radiology-BIRADS score. Patients with a palpable breast lump, pain, nipple discharge, skin dimpling, or skin changes over breast and nipple inversion or other nipple abnormalities were included in the study.
Results: Comparison based on the diagnostic accuracy of mammography alone and mammography plus DBT based on BIRADS score revealed DM had a sensitivity of 96%, specificity of 40.6%, a positive predictive value (PPV) of 72.9% and negative predictive value (NPV) of 86.7% with an accuracy of 75.3% while DM plus DBT had a sensitivity of 98.1%, specificity of 46.9%, the PPV of 75.4%, and NPV of 78.8%. There was no significant increase in sensitivity (P=1.000), specificity (P=0.614), PPV (0.734), and accuracy (0.584).
Conclusion: DM plus DBT does not change the BIRADS scoring but its addition increases the diagnostic confidence while there is no significant increase in sensitivity/specificity/PPV/NPV or diagnostic accuracy using DM plus DBT.
Does age and start of Ponseti treatment affect the functional outcome in club foot: A comparative study
Authors: Ravindra Mohan  , Adarsh Kishore Singh  , Deepak Kumar  , Shailendra Singh  , Arpit Singh  , Narendra Singh Kushwaha  , Abbas Mohammad Baqar
Published: January 2025

Background: Idiopathic clubfoot is one of the most common and complex congenital deformities which are difficult to correct.
Aims and Objectives: The present study was designed to assess the effectiveness and results of the Ponseti method’s early use in the treatment of idiopathic congenital talipes equinovarus (CTEV).
Materials and Methods: Seventy-six feet in 50 patients of CTEV during the period of May 2019–May 2020 were studied. All the cases were treated by Ponseti technique. Children with idiopathic CTEV and age <1 year were included in our study. The severity of deformity was graded according to Pirani scoring system both at the beginning and at the end of treatment.
Results: The mean age at presentation was 2.77 months. The mean initial Pirani score at time of presentation was 4.07, and at last follow-up was 0.13. We observed that 63 feet (82.89%) out of 76 feet required a percutaneous TA tenotomy along with plaster casting to correct the equines deformity. The mean total number of casts required to correct the deformity was 6.4. The mean duration of treatment from 1st plaster cast to cast for equinus correction was 8.4 weeks. About 94% of cases had a good outcome at last follow-up which was evaluated on the basis of Pirani score. The association of duration of treatment (weeks) with age and total number of cast with age has P=0.002 which was found to be significant.
Conclusion: The Ponseti technique is a very safe, efficient, and acceptable economical treatment for the correction of CTEV that gives excellent results on conservative treatment and in most of the cases avoid surgical intervention if protocol followed as prescribed. If the age of the patient is higher at time of presentation, it requires a longer casting period and more number of casts to correct the deformity compared to younger children with the early presentation.
Study of knowledge, attitude, and practice of contraception among antenatal women at tertiary care hospital in Western Rajasthan
Authors: Kannupriya Choudhary  , Ritu Bijarnia  , Rizwana Shaheen  , Kamal Kumar Yadav  , Vinita Jangir  , Seema Kalasua  , Sandeep Choudhary
Published: January 2025

Background: The global population today stands at 7.7 billion and is expected to reach 9 billion by year 2045.1 Increasing population is a global problem today. India is the largest demographic country of the world, posses 2.4% of world land area and supports 16% of world’s population. India is going to be the highest populous country in the world by the year 2050.
Aims and Objectives: The aim of the study was to assess the knowledge, attitude, and practice of contraception among antenatal women attending ANC clinic at Umaid Hospital.
Materials and Methods: An observational and cross-sectional study conducted in department of Obstetrics and Gynaecology at Umaid Hospital, Jodhpur.
Results: Our study revealed that majority (86%) of illiterate women not using contraceptive methods while users of contraceptive increase with education, contraception usage was found more in urban area (51%). Majority (95%) of participants had some knowledge about methods of contraception, commonly heard method was tubectomy (87%) followed by IUCD (68%), condoms (64%), and pills (61%), but this knowledge is not leading to increased practice, as only 43%participants had used contraception. Family acted as major source of information (35%) followed by health care worker (27%). Most of users accessed contraception from pharmacy (43%) followed by health center (24%). Most common reason to use contraception is to give gap between kids (33%) followed by, to prevent unwanted pregnancy (25%). Near 60% of participants agreed that husband opinion is the most important factor for choice of contraception.
Conclusion: The consciousness to curb the rapid growth of population is rampant all over the world. Extensive efforts are being made in the developing countries to reduce the existing crude birth rates through the developing countries to reduce the existing crude birth rates through the development and reforms of indirect measures such as social, economic, cultural, health, and educational besides the direct programs of family planning.
Prevalence of undernutrition and associated risk factors among under five children in rural Haldwani
Authors: Preeti  , Sadhana Awasthi  , Rupali Gupta  , Thakkar Hemaben Kanubhai
Published: January 2025

Background: The foundation of any nation is children. Malnutrition in children is global issue that may have both short- and long-term irreversible negative health consequences and thus associated with morbidity and mortality.
Aims and Objectives: The study aims to determine the prevalence and associated risk factors of under-nutrition among under-five children in rural area of Haldwani.
Materials and Methods: A community-based cross-sectional study conducted on Four hundred children residing in the rural field practice area of the Department of Community Medicine, Government Medical College, Haldwani.
Results: The prevalence of underweight, stunting, and wasting was 7.75%, 9.25%, and 4%, respectively among under five children. The risk factors found significantly associated with undernutrition and sociodemographic profile were family size, parent’s education, mother’s occupation, and the socioeconomic class. The maternal factors found significantly associated with undernutrition were intake of iron folic acid tablets during antenatal care and postnatal care period, duration of pregnancy, site of delivery. Prelacteal, colostrum given, exclusive breastfeeding, and age of introducing complementary feeding and occurrence of recurrent diarrhea, recurrent acute respiratory infection, and worm infestation were child characteristics and medical illness found significantly associated with undernutrition.
Conclusion: In this study, 17.5% of children were found undernourished. Factors determining undernourishment were parents literacy, social class, type and size of family, iron folic acid taken during pregnancy, feeding practices, immunization status, history of recurrent diarrhea, and other infections in the past 1 year.
Exploring Healthcare Seeking Behavior Among Patients with Ischemic Heart Disease and Stroke; A Cross-Sectional Study in a Tertiary Care Centre in South India
Authors: Kokila Kolandasamy  , Uma Priyadharsini Thulasimani  , Usha Devarasu  , Sundaram Parameswaran Mruthulagi
Published: January 2025

Background: Ischemic heart disease (IHD) and stroke represent the leading cause of mortality globally. Delays in seeking medical attention that result in diagnostic and treatment delays are significant roadblocks in achieving the best possible treatment outcomes for IHD and stroke.
Aims and Objectives: This study aims to assess the pattern of healthcare seeking behavior among patients of IHD and stroke in a tertiary care hospital at Salem District in Tamil Nadu, South India.
Materials and Methods: This cross-sectional study was conducted among 250 patients of IHD and stroke. A validated and structured questionnaire was used to collect information on socio-demographic details, knowledge, and health-care seeking behavior with regard to IHD and stroke based on the Health Belief Model.
Results: The mean age of study participants was 60 years with a male preponderance (56%). About 75% of IHD patients and 61.9% of stroke patients had no formal education. The prevalence of hypertension (74%) was higher than diabetes mellitus (45.6%) among the study subjects. The seriousness of the initial symptoms of IHD and stroke was perceived only by 7.75% of IHD patients and 2.23% of stroke patients. Alarmingly, 39.66% of IHD patients and 61.2% of stroke patients were not aware of any risk factors for IHD and Stroke. Only 21.56% of IHD patients and 14.17% of stroke patients sought immediate medical assistance whereas the others ignored the symptoms or did not undergo treatment even after knowing the symptoms of the disease.
Conclusion: This study depicted suboptimal healthcare seeking behavior and significant lack of knowledge about risk factors, initial symptoms, preventive measures, and reasons for pre hospital delay related to IHD and stroke. The study yields valuable references to incorporate the pattern of health-care seeking response of the community along with their sociocultural and economic factors in designing and implementation of any health program.
NAFLD is a risk factor for the development of diabetic nephropathy in patients with T2DM
Authors: Usmani MH  , Karan Saran Kapur  , Sisodiya Ranjeet Singh
Published: January 2025

Background: Non-alcoholic fatty liver disease (NAFLD) and diabetes are two common health problems of global concern. Diabetic nephropathy (DN) is also a microvascular complication of diabetes. However, there is little knowledge about the relationship between NAFLD and DN.
Aims and Objectives: The aim of this study was to know the association between NAFLD and DN in type 2 diabetes mellitus (T2DM) patients.
Materials and Methods: A cross-sectional study was conducted on 136 patients of T2DM admitted to Sanjay Gandhi memorial Hospital, Rewa. Using abdominal ultrasonography, patients were grouped as patients, with NAFLD and patients without NAFLD. Then, patients were screened for DN (microalbuminuria) using the dipstick method. Liver and kidney function tests and complete blood count were performed along with FBS, PPBS, and HbA1c. Data were analyzed by appropriate statistical tests by Wizard 2® (Version 2.0.12 (259)) software. P<0.05 was considered significant.
Results: In this study, 61 (44.85%) patients were found to have NAFLD, and 30 (49.81%) also had DN. Out of 75 (55.14%) non-NAFLD patients, 21 (28%) had DN. The data were statistically significant (OR: 2.4885, 95%, P=0.0120). The mean estimated glomerular filtration rate (eGFR) (mL/min/1.73 m2) among subjects with FIB4 score ≥2.67 was 77.33±9.54 and was less as compared to the mean eGFR among subjects with FIB4 score <2.67 (104.12±5.23) (student t-test, t (134)=2.247, P=0.026).
Conclusion: NAFLD might be a risk factor for the development of DN in T2DM patients.
Knowledge and treatment seeking behavior regarding malaria among the residents of tribal dominated areas of Mandla district in central India – A cross-sectional study
Authors: Thakur Aditya , Pradeep Kumar Kasar  , Shashi Prabha Tomar  , Kunal Peepre
Published: January 2025

Background: Malaria is both a result and a cause of a lack of development. Dearth of information, education, and communication activities and awareness, knowledge regarding malaria is poor particularly in tribal population of Mandla.
Aims and Objectives: The aim of the study was to assess the malaria knowledge and treatment-seeking behavior among the residents of the tribal dominated areas of Mandla district and to study their association with the sociodemographic characteristics.
Materials and Methods: A total of eight villages were selected from which 25 households were randomly selected making a total sample size of 200 households, from these 200 households, 200 adult respondents were identified for administration of the study questionnaire.
Results: The age of the respondents ranged from 18 to 80 years, with a mean age of 37 years (SD=14.7). Overall, 48.5% of respondents had correct knowledge about perceived cause of getting malaria. The treatment seeking behavior of the respondents were associated with sociodemographic profile of the participants the age of the participants, the association was found to be highly statistically significant (P=0.001).
Conclusion: Malaria prevention campaigns should be tailored according to knowledge gaps, practices, environment, resources, and preferences in different areas of the Mandla District, using the health education/awareness most likely to outreach the far corners of the district where most residents were tribals.
Correlation between the bleeding coagulation tests before vertebral surgery and the perioperative bleeding amount in geriatric patients using antiaggregants and anticoagulants
Authors: Yardimci Bulent , Meric Enercan  , Azmi Hamzaoglu  , Reyhan Diz Kucukkaya  , Nomin Bold
Published: January 2025

Background: The world is witnessing an increase in its elderly population, which is reflected in the growing number of orthopedic surgeries being performed. With the increase in the number of major operations performed on the elderly, it has become crucial to manage bleeding effectively during vertebral surgery. The substantial use of antiaggregants and anticoagulants in elderly patients presents an increased risk of bleeding, resulting in increased morbidity and mortality rates if not well managed. Hence, it is essential to evaluate these patients thoroughly in the pre-operative period to minimize the risk of bleeding and improve patient outcomes.
Aims and Objectives: The aims of this study were to research how effective the use of antiaggregants (AAs) and anticoagulants (oral anticoagulants [OAC] and low-molecular-weight heparin [LMWH]) is on operations and post-operative bleedings in surgery performed at our orthopedics clinic especially in the geriatric age group.
Materials and Methods: This study was made retrospectively on 80 patients aged 65 years and over, who have undergone vertebral surgery on hospitalization at the Istanbul Florence Nightingale Hospital’s Orthopedics Clinic between the months of January 2017 and December 2019.
Results: The rate of blood product utilization during surgery of those using prophylactic LMWH was statistically significantly higher in comparison to those not on prophylactic LMWH (P=0.034). There has not been determined any statistically significant difference in the means of the bleeding amount during the operation and post-operative bleeding. There has not been determined any statistically significant difference in the means of the bleeding amount during the operation and the post-operative period use and do not use any AA.
Conclusion: In the geriatric group of age, which shall undergo vertebral surgery, it seems like an appropriate approach to discontinue AA and OAC 7 days before the operations. We have observed that the utilization of LMWH either for prophylactic purposes or for bridging purposes in the group using OAC does not significantly increase the bleeding probability.
Efficacy of categorization of urothelial malignancy in atypical urine samples by the Paris system for reporting urinary cytology
Authors: Thameem A  , Sankar Sundaram  , Deepa Sujatha
Published: January 2025

Background: Urine cytology is an important screening tool of patients for urothelial carcinoma and follow-up of patients. Ease of procurement, cost-effectiveness, and lower turnaround time are the advantages.
Aims and Objectives: The aim of the study was to identify the accuracy of TPS criteria in diagnosing HGUC, considering biopsy as the gold standard and to describe the cytomorphological features in atypical urine specimens and categorization as per reference to TPS of reporting urine cytology. Definition – Atypical urine sample: Urine samples of patients with macroscopic hematuria and other unexplained urinary symptoms, suspicious of urothelial malignancy.
Materials and Methods: The study was performed on patients attending urology OPD with macroscopic hematuria and other unexplained urinary symptoms, which were suspicious of urothelial malignancy and whose urine cytology and subsequent biopsy specimens were submitted to the Department of Pathology. Continuous sampling of 56 patients was done. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were used to compare TPS with histopathology. SPSS was used to assess correlation, done by diagnostic test evaluation.
Results: Age group of study population ranges from 40 to 84 years with mean age of population as 62 years. Sensitivity, specificity, PPV, and NPV of TPS for reporting urinary cytology in the investigation were 85%, 75%, 65.38%, and 90%. Combination of elevated nuclear-to-cytoplasmic ratio, irregular nuclear border, and hyperchromasia was predictive of malignancy.
Conclusion: The criteria outlined by TPS facilitated the standardization of urine cytology reporting and significantly increased the sensitivity of diagnosing HGUC.
Seroprevalence of SARS-CoV-2 in treatment naïve patients of rheumatological diseases
Authors: Mahendra Kumar  , Aman Sharma  , Ranjana Walker Minz
Published: January 2025

Dear Sir,COVID-19 is of paramount concern in the rheumatology community. As per current consensus, patients of rheumatological diseases (RDs) are at higher risk of SARS-CoV-2 infection than the general population (high agreement but very low grade of evidence); however, contradictory reports are available regarding its seroprevalence and association with severity and mortality.
However, these inferences are mainly based on patients who have long-standing RDs and on various therapies. Then what would happen to those who are treatment-naive, mildly symptomatic, or carrying this disease unknowingly in the community during this pandemic? To explore this aspect, we screened blood samples of clinically suspected patients of autoimmune diseases (ADs) for COVID-19 IgG antibody during the pandemic in the pre-vaccination period. Based on clinical profile, antinuclear antibody (ANA), antineutrophilic cytoplasmic antibody (ANCA), and myositis-associated autoantibodies were tested.
Out of 268 clinically suspected cases of RDs, 131 samples were positive for autoantibodies: RD group (114 ANA+08 myositis associated antibody+09 ANCA), and the rest 137 were negative (non-RD group). Out of these, three samples each from RD (3/131; 2.29%) and non-RD group (3/137; 2.17%) turned out to be positive for COVID-19 IgG antibody (EUROIMMUN, Germany), suggesting no increased prevalence of COVID19 in patients of the RD group (OR=1.046, 95% CI: 0.145–7.53, P=0.9645). Among the RD group, two patients were finally diagnosed with systemic lupus erythematosus (SLE); however, others did not turn up again to the hospital to comment on the final diagnosis. None of these COVID-19 positive patients had any known comorbidities or RD-related treatment. These positive patients from both groups had almost similar mildto-moderate COVID-19 disease courses with a favorable outcome.
A meta-analysis found a marginal association of ADs with increased risk of severity and mortality of COVID-19 disease (Risk of severity: OR=1.21, 95% CI: 0.58–2.5, P=0.79; Risk of mortality: OR=1.31, 95% CI: 0.33–5.2, P=0.95); however, the difference was not significant. Studies have documented COVID-19 frequency of 2.4% (4/165) among SLE patients with severe cases mostly in coexisting comorbidities. Even recent consensus has suggested older age, presence of comorbidities, and use of prednisolone ≥10 as a risk factor for poor outcome in these two coexisting diseases. Unlike the previous reports, the present study highlighted the susceptibility of treatment naïve cases of RDs for COVID-19. The RD group either has an almost similar SARS-CoV-2 prevalence as the non-RD group (2.29% vs. 2.17%) or even lowers than the general population (2.29% vs. 7%).
In conclusion, RD itself does not seem to be a risk factor for SARS-CoV2 infection, even in treatment naïve patients; however, disease outcome may depend on various coexisting factors/comorbidities. Inter-talk between SARS-CoV-2 and RDs yet to be explored.
Neonatal transfusion-related acute lung injury a rare complication of exchange transfusion - A case report
Authors: Singh Ranjana , Atul Kumar Saroj
Published: January 2025

Transfusion-related acute lung injury (TRALI), a life-threatening condition, remains an under reported complication, especially among neonates postexchange transfusion for unconjugated hyperbilirubinemia. Appropriate recognition and prompt treatment change the prognosis for good. The present case emphasizes that TRALI must be kept as a differential diagnosis in previously well neonates presenting with sudden onset hypoxia within or during 6 h of transfusion with evidence of bilateral infiltrates on a frontal chest radiograph, and no evidence of circulatory overload, left atrial hypertension, or pre-existing respiratory distress before transfusion. We report the rare occurrence of TRALI and its successful management with supportive hemodynamic management and corrective ventilator strategies.
Paradoxical mortality differential of HDL cholesterol
Authors: Jyotishman Mukhopadhyay  , Debayan Mallik  , Sughandha Garg
Published: January 2025

High-density lipoprotein (HDL) cholesterol has been known for ages to be cardio-protective due to its defensive action against genesis of atherosclerosis. Increasing the serum HDL cholesterol (HDL-C) as a prospective potential to prevent coronary heart disease could not prove beneficial in human trials that put forward a major concern about the role and functional contribution of HDL-C in human health. Many observational studies indicated that extreme high value of serum HDL-C is often associated with high cardiovascular mortality; therefore could be considered as detrimental for healthy survival. Furthermore, observational and genetic studies revealed a possible link between extreme low serumHDL-C and development of common noncardiovascular diseases such as infectious disease, autoimmune disorder, malignancy, type-2 diabetes, kidney, and pulmonary diseases. This review endeavors to update on the various reasons of mortality observed with extreme values of HDL-C reflected in the recent studies along with the probable role of HDL-C in the pathogenesis of these ailments.
Incidence of respiratory infections and its correlation with smoke exposure among infants from an urban field practice area in Tamil Nadu
Authors: Saravana Kumar P  , Subhalakshmi R  , Rajasekeran C  , Elizabeth Varakumari Janakiraman
Published: January 2025

Background: Children’s acute lower respiratory infections are most prevalent among new-born. Clinical evaluation and symptoms help to establish the connection between smoke exposure and acute respiratory tract infection (ARTI). Furthermore, there is proof that exposing children to coal smoke considerably increases their risk of developing ARTI.
Aims and Objectives: This study was designed to estimate the incidence of respiratory tract infection (RTI) among selected cohort of infants in urban field practice area of Tamil Nadu and to correlate the incidence of RTIs with smoke practices.
Materials and Methods: In Tamil Nadu’s urban field practice area, a cohort study of infants was done. A house-to-house survey was conducted and information was gathered among 150 newborns who were tracked after being selected as a period sample based on inclusion criteria at a 15* visit. Numerous data on ARI episodes, housing circumstances, and smoke exposure were gathered and correlated. Software such as Epi info and SPSS version 22 were used to analye data.
Results: The incidence of TI was calculated to be 1.7 episodes per 100 person days and 4.7 on average among the 150 newborns chosen. Nearly 48% of people lived in huts, 84% had indoor kitchens, and 75% cooked with gas. Infants who appeared to regularly be exposed to passive smoking have a little increase in the incidence of mean RTI bouts.
Conclusion: The additional hospital admissions, which are entirely preventable, place a heavy load on the public health system. It is evident that new initiatives are required to stop infants from being exposed to passive smoke during and after pregnancy. Improving international Electrotechnical commission activities play an active role is reducing incidence of RTIs among infants. Intensified educational interventions on ill effects of indoor and outdoor smoke, passive smoking helps in addressing the issue.
Feasibility of urolithiasis management after studer neobladder urinary diversion: A multicenter center study
Authors: Arvind Kumar  , Anurag Dubey  , Praveen Lakhera  , Prashant Patel  , Avinash Pratap Singh Thakur  , Fanindra Singh Solanki
Published: January 2025

Background: Stones formation is a common complication after cystectomy including stones of the upper urinary tract and reservoir or conduit. Advances in instrumentation and techniques have expanded treatment options, while minimizing morbidity.
Aims and Objectives: Feasibility of urolithiasis management after urinary diversion surgery.
Materials and Methods: Eleven patients of diversion with stone were observed from January 01, 2015, to July 30, 2022. Operative procedures were decided on basis on stone locations and size. Perioperative parameters were observed and compared with similar studies. Percutaneous nephrolithotomy, percutaneous-based antegrade ureteroscopy with semi-rigid or flexible ureteroscope, transurethral reservoir lithotripsy, percutaneous pouch lithotripsy, and open operation were performed. The operative finding and complications were retrospectively collected and analyzed.
Results: The mean age of the patients was 53.2±8.1 years and mean pre-operative stone diameter was 3.1±3.5 cm. Three patients suprapubic cystolithotomy, two patients percutaneous cystolithotripsy, two patients percutaneous nephrolithitomy, two patients extracorporeal shock wave lithotripsy, one patient per urethral cystolithotripsy/cystolitholapexy, and one patient ureteroscopy/flexible ureteroscopy were done. The male-to-female ratio was 9/2. Stone-free rate was 100% after single session of treatment. In the post-operative period, fever was observed in two patients, and urinary leakage through wound site in one patient.
Conclusion: Stone surgery after urinary diversion is challenging, success of treatment depends on experience of surgical team, pre-operative preparation, and correct instrumentations.
Study of clinical and biochemical profile of scrub typhus in a tertiary care hospital of West Bengal
Authors: Rakesh Mandal  , Sarmila Guha Banerjee  , Arunima Sinha  , Ujjwal Bandyopadhyay  , Arijit Sinha
Published: January 2025

Background: Humans are accidental hosts in the zoonotic disease Scrub typhus. The disease though widespread in our county, it remains grossly underdiagnosed because of its non-septic clinical manifestations and lack of access to specific laboratory facilities.
Aims and Objectives: The objective of present study is to evaluate the clinical presentations of Scrub Typhus among the study group. Furthermore, to assess the various laboratory findings in Scrub Typhus cases among the study group is the other objective of this study.
Materials and Methods: The present study is an Institution-based, observational, and cross-sectional study conducted for 18 months with the admitted patients having 14–70 years of age. Data collected regarding patients’ demographic profile, symptoms, clinical findings, laboratory, and radiological findings. Data had been summarized as mean and standard deviation for numerical variables and count and percentages for categorical variables.
Results: In our study, we found that most of the patients were 14–20 years old and female population was higher. It was found that 34.3% of patients had Eschar, 42.9% of patients had Rash, and 91.4% of patients had Pallor, 8.6% of patients had Ascites, 25.7% had Edema, 8.6% of patients had Jaundice, 11.4% had shock, and 57.1% had pneumonia/pneumonitis. The present study showed that 65.7% of patients had drug response (Doxycycline).
Conclusion: Knowledge of geographical distribution, evidence of exposure to vector, clinical features such as fever, rash, eschar, headache, and myalgia along with high index of suspicion are crucial factors for early diagnosis and that helps in timely treatment of the cases.
Delay in healthcare seeking, diagnosis, and treatment of patients with tuberculosis: A cross-sectional study
Authors: Mahendra Chouksey  , Arya Vimal , Nilima Takhelchangbam
Published: January 2025

Background: One of the greatest challenges in the fight against tuberculosis (TB) is the delay in seeking medical care among those who are sick. This can be complemented by delays in providing prompt health-care services.
Aims and Objectives: The aims of this study were to estimate the number of patients facing delays and to understand the various reasons for individual and health system delays.
Materials and Methods: In this cross-sectional study, new sputum positive cases of >18 years registered at the two TB Units of two community health centers of a district in Uttar Pradesh from March 2018 to April 2019 were included. The primary outcome was patient delay and health system delay. They were assessed from patient interviews as well as through records.
Results: A total of 120 patients were included in the study of which, 76 had been subjected to one or the other form or a combination of delay. The factors such as age, education level, occupation, socioeconomic condition, and the walking duration to the nearest health center were found to be significantly associated with delay. The patient delay was seen in 37 (30.8%) with median delay of 45 days (interquartile range [IQR] 37–53). The health system delay was observed in 48 (40.0%) patients with median delay of 24.5 days (IQR 12.0–47.2).
Conclusion: In spite of robust program implementation, patient factor delays continue to prevail which contributes to the total delay. Addressing delay in Tb is of utmost important so as to progress to TB elimination.
Facial nerve palsy: An atypical presentation of dengue fever
Authors: Rishav Mukherjee  , Debarup Das
Published: January 2025

Dengue fever is a grave public health concern in tropical countries. The disease spectrum of dengue fever is multi-systemic, although neurologic complications of dengue fever is relatively uncommon. The pathogenesis of neurologic manifestations in dengue fever is not well understood and may be due to the neurotrophic effect of the virus, or related to the systemic effects of dengue infection, and immune mediated. Here in, we discuss the occurrence of isolated 7th cranial nerve lower motor neuron type palsy in a 23-year-old lady suffering from dengue fever. To date, there are very few case reports citing the involvement of facial nerve in dengue fever.
Clinicoradiological evaluation and outcome assessment of single-stage posterior correction of atlantoaxial dislocation
Authors: Avinash Kumar  , Vivek Kumar Kankane  , Aditya Srivastava  , Avdhesh Shukla  , Mayank Jeswani  , Avinash Sharma
Published: January 2025

Background: Atlantoaxial dislocation (AAD) refers to loss of stability between atlas and axis vertebrae, resulting in loss of normal articulation. It may be due to congenital, traumatic, or inflammatory reasons. Various techniques of atlantoaxial fixation have been described and used in patients over the years, but each has its own merits and demerits.
Aims and Objectives: The aim of the study was to study clinicoradiological evaluation and outcome assessment of single-stage posterior correction of AAD.
Materials and Methods: This is a prospective study done in the Department of Neurosurgery, JA group of hospitals, Gajra Raja Medical College, Gwalior, from July 2021 to July 2022. The study was conducted on 20 randomly selected patients whose presentation and imaging showed indication for surgery.
Results: C1 lateral mass C2 pars screw fixation had one Frankel grade improvement in 6 months in 96% patient with a fusion rate of 100% and the patient also has modified Japanese orthopedic association score improvement of 15.25±0.98.
Conclusion: This study reviewed single-stage posterior correction of AAD using C1 lateral mass and C2 pedicle screw and rod fixation; it enables the stabilization of atlantoaxial motion and preserves motion at occipito-atlantal level with high fusion rates, good neurological recovery, and minimal complications.