bluuebunny/crossref_metadata_2025 huggingface dataset:
Should planning of cervical pedicle screws be race specific? Computed tomography–based morphometric analysis
Authors: Agarwal Ashish , Agarwal Anant , Kumar Ashutosh
Published: May 2024

Introduction:

The neurovascular surgical structures are protected by quantitative understanding of cervical pedicle morphology and aiding in better surgical outcome. Aim of the study is to do morphometric analysis of subaxial cervical pedicle by noncomputerized computed tomography (CT) scans.

Materials and Methods:

From 50 volunteers, a total of 500 cervical pedicles were evaluated using axial and sagittal CT scan. Five parameters such as outer pedicle width (OPW), inner pedicle width (IPW), pedicle height (PH), pedicle transverse angle (PTA) and pedicle axis length (PAL) were analyzed.

Result:

OPW, IPW, PH, and PAL show increase in values from C3 to C7, while PTA shows a decrease in value from C3 to C7.

Conclusion:

The cervical pedicle dimension of our study population was smaller than other studies carried out on Asian and European population. Hence, the planning for pedicle screw fixation should be race specific.
Translational Research in Health Care
Authors: Singaram Muthu , Muraleedhran VR , Sivaprakasam Mohanasankar
Published: May 2024

Background and Objective:

The translational research objective is to produce meaningful and applicable results that directly benefit the community. The objective of translational research is to move from traditional research discoveries rapidly and efficiently into practice. Translational research encourages and promotes multidisciplinary collaboration among clinicians, researchers, industry, policy makers, and other related stakeholders. It further incorporates the needs of the general public with communities being engaged to determine their requirements for health invention. It identifies and supports medical and health practices. Translational research is frequently classified by which stage of restatement (from beginning exploration to societal operation and impact) it falls into. Translational research is the process of turning compliances in the laboratory, clinic, and community into interventions that apply to the health of individualities, public from diagnostics, and to medical procedures as well as behavioral changes.

Methods:

This study adopted a qualitative research methodology based on Hill et al. consensual qualitative research (CQR) to build multiple case studies to acquire the information. We ion.opted to apply a modified method of CQR[9] based on multiple case studies. This is an emerging methodological approach in research.

Results:

Based on the 24 semi-structured interviews, these interviews were directly with researchers who carry out the research. Twenty-four voluntary researchers participated in the research and these semi-structured interviews were made into 24 case studies to be analyzed. Each case study was built based on the questions on methods of research. These were used to identify and build the tools for practicing translational research.

Conclusion:

There is a huge untapped potential for India in the area of translational research.
Comparison of Efficacy of Erector Spinae Plane Block with Paravertebral Block for Postoperative Analgesia in Patients Undergoing Breast Cancer Surgery
Authors: Singh Arjun , Agrawal Nidhi , Baruah Udismita , Sandill Surabhi
Published: May 2024

Background:

Patients undergoing modified radical mastectomy (MRM) experience acute pain. Inadequate acute postoperative pain control may lead to anxiety, hemodynamic imbalance and development of chronic pain syndrome. Hence analgesia is extremely important for favourable outcome. This study was undertaken to compare the efficacy of ultrasound guided thoracic paravertebral block (TPVB) versus ultrasound guided thoracic erector spinae plane block (ESPB) with clonidine as an adjuvant to local anaesthetic for post-operative analgesia in modified radical mastectomy.

Method:

This prospective randomized interventional comparative trial, involving 60 patients were undergoing modified radical mastectomy for breast cancer surgery, was conducted in a tertiary care teaching hospital over 18 months. Sixty patients undergoing MRM for breast cancer under general anaesthesia were enrolled. The patients were randomly allocated into one of the two groups. Group E received ultrasound guided erector spinae block and Group P received Paravertebral block at the level of 4th thoracic vertebra (T4). Both the groups were given 21 mL of 0.5% ropivacaine and 1 μg/kg of clonidine diluted in 1 mL of saline (making total volume of up to 22 mL). Primary outcome measure was to compare duration of analgesia, that is from the time of block administration till the time to first rescue analgesia demanded by the patients. Secondary outcome measures were mean visual analogue scale (VAS) score at rest as well as during abduction of ipsilateral arm at various time points, total intraoperative fentanyl and tramadol requirement up to 24 hours postoperatively; postoperative nausea and vomiting; patients satisfaction at the end of 24 hours postoperatively.

Statistical method used:

Quantitative variables were compared using Independent t-test/Mann-Whitney Test (when the data sets were not normally distributed). Qualitative variables were compared using Chi-Square test /Fisher’s exact test. A p value of <0.05 was considered statistically significant.

Results:

Duration of analgesi, that is, time of first rescue analgesia from the administration of the block was comparable between the two study groups. The mean (SD) duration of analgesia in group E was 22.78 (3.31) hours and in group P was 22.88 (3.34) hours (P = 0.914). Both the groups were comparable in terms of fentanyl requirement and total 24 hours tramadol requirement Other parameters like postoperative nausea vomiting, effect on hemodynamic and overall patient satisfaction were also comparable between the two groups.

Conclusions:

Both ultrasound guided ESPB and TPVB are equally efficacious in providing postoperative analgesia in patients undergoing modified radical mastectomy.
Assessment of Periodontal Status in the Patients with Chronic Obstructive Pulmonary Disease (COPD)
Authors: Shree Shanta , Khan Rehbar , Pathak Vivek , Pandey Anuj Kumar , Verma Ajay Kumar , Singh Devendra Kumar
Published: May 2024

Background:

Oral infections, especially periodontal diseases, may affect the course and pathogenesis of a number of systemic diseases including respiratory diseases. The current study aimed to determine the periodontal status in the patients with chronic obstructive pulmonary disease (COPD).

Materials and Methods:

The study consisted of 65 COPD patients (case) and 65 healthy individuals (non-COPD). Individuals in the case group were well-functioning, ambulatory patients having COPD as determined by their history, clinical examination, and spirometry. Periodontal status was evaluated by the indices, namely, simplified oral hygiene index (OHI-S), plaque index (PI), gingival index (GI), pocket probing depth (PPD), and clinical attachment level (CAL) in both the groups.

Results:

In the studied population, the mean (± standard deviation, SD) age was higher in COPD group (50.3 ± 11.4) compared to the control group (41.9±8.1; P < 0.0001). In the COPD group, average smoking index was 369.3 ± 167.2, while in control group, it was 323.88 ± 132.8 (P = 0.889). Our data show that individuals in the COPD group had significantly higher OHI-S, PI, GI, PPD, and CAL (P < 0.0001) compared with the control group. The mean score of OHI-S, PI, GI, PPD, and CAL was higher in moderate and severe COPD patients compared to mild COPD patients; however, this difference was not statistically significant.

Conclusion:

The patients with COPD showed poor oral hygiene and a higher prevalence of periodontal disease. Prevention and treatment of periodontal disease could be included in the planned intervention campaigns designed to help patients with COPD.
The clinical, sociodemographic, and pharmacotherapeutic characteristics influencing quality of life in patients with epilepsy
Authors: Qanoongo Faheem Nazir , Faheem Mehreen , Raina Adnan Firdous , Shah Parvaiz
Published: May 2024

Background:

It is becoming widely understood that evaluating a patient’s quality of life (QOL) is crucial to managing their epilepsy. The study aimed to explore the impact of sociodemographic, clinical, and pharmacotherapy factors on QOL in patients with epilepsy.

Methods:

This was a cross-sectional study conducted over 2 years at the outpatient and inpatient Department of Medicine (Neurology Division) of SMHS Hospital, affiliated with Government Medical College, Srinagar. The patients with epilepsy with a definite diagnosis of epilepsy as per the International League Against Epilepsy (ILAE) guidelines were included.

Results:

Patients on polytherapy had significantly lower scores for overall QOL, energy/fatigue, medication effects, social functioning, and overall score. Patients on monotherapy scored significantly lower for the said domains, including the seizure worry domain, compared to those patients with epilepsy who were antiepileptic drugs (AEDs) naive.

Conclusion:

Individuals who were receiving monotherapy had greater QOL scores than those who were receiving traditional AEDs and had focal epilepsy. Furthermore, in patient with epilepsy, all QOL domains were significantly predicted by increased seizure frequency and the presence of adverse drug reactions (ADRs).
Oxygen Delivery Devices in Hypoxemic Respiratory Failure
Authors: Singh Ranvijay , Garg Sandeep , Aggarwal Sunita , Hira HS , Singh Ranvir
Published: May 2024

Oxygen therapy by appropriate oxygen delivery device (ODD) at different stages is an essential part of hypoxemic respiratory failure management. The choice of ODDs depends on the degree of hypoxemia, precision of delivery, patient comfort, risk of transmission of infection to Health Care Worker (HCW), and the cost. Management of hypoxemic respiratory failure depends on underlying etiology and pathophysiology of the disease process. Study from the current global pandemic of novel coronavirus disease 2019 (COVID-19) showed that the severity of hypoxemia is independently associated with in-hospital mortality and can be an important predictor risk of admission to intensive care unit. In this review, we will discuss the different ODDs, their indication for use along with the advantages and disadvantages.
Retropupillary iris-claw lens
Authors: Singh Rahul , Ramraika Divya , Kapadia Seemee , Agrawal Saket , Ramraika Moon
Published: May 2024

Aim:

To evaluate the preoperative and intraoperative indications, postoperative complications, incidence of secondary glaucoma, and visual outcome in patient who underwent iris-claw implantation during cataract surgery and effect of vitrectomy on postoperative intraocular pressure (IOP).

Material and Methods:

A retrospective study was conducted from January 2016 to February 2020. One hundred eighty-seven eyes of 187 patients who underwent iris-claw lens implantation, with minimum 1 month follow-up, were included in the study. Analysis of records was done for preoperative, intraoperative findings and was recorded and postoperative best corrected visual acuity (BCVA) and IOP were noted in each follow-up.

Results:

Mean preoperative BCVA of 187 eyes was 1.78 logMAR (SD 0.68), which increased to 0.61 ± 0.50, 0.36 ± 0.26, 0.21 ± 0.16 logMAR at postoperative day 1, day 7, and 1 month, respectively. Most common indications included phacodonesis (17.65%), small dilating and nondilating pupil (11.22%), zonular dialysis (6.41%), and pseudoexfoliation in (4.81%). Few patients (6.94%) had preexisting corneal pathologies which lend up in intraoperative complications that lead to iris-claw implantation. Mean IOP in vitrectomized eye after 1 month was 15.53 (SD 2.16) mm Hg and those of nonvitrectomized was 16 (SD 1.90) mm Hg. Posterior capsular rent and whole capsular bag loss were the most common intraoperative indications. Incidence of secondary glaucoma was 2.13%. Irregular pupil was the most common anterior segment finding at 1 month postoperatively.

Conclusion:

Retropupillary iris-claw implantation is one of the safe and least complicated methods of managing intraoperative complications which gives good visual acuity and prevent patient from the trauma of multiple surgeries.
Patient-reported Outcomes of SARS-CoV-2 Positive Adult Orthopedic Trauma Patients Treated During the Ongoing Pandemic
Authors: Bajaj Vineet , Khan Yasim , Kashyap Abhishek , Ram Devajee Bharat , Arora Saurabh , Arora Sumit , Kumar Vinod , Maini Lalit
Published: May 2024

Background:

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic has become a matter of concern all over the world. It has resulted in delay in surgery or, at times, preference for nonoperative treatment for SARS-CoV-2 positive orthopedically injured adult patients which may adversely affect the clinical outcomes. In this study, we report the outcomes of orthopedic adult trauma patients who tested positive for SARS-CoV-2 at admission.

Methods:

We retrospectively reviewed the prospectively collected data from the period between April 1, 2020 and December 31, 2020. We reviewed 521 out of total 2435 patients presenting in the casualty that required orthopedic trauma surgery. Thirty-eight out of total 521 patients, that tested positive for SARS-CoV-2, were followed-up using telecommunication for final outcome of fracture treatment. A telecommunication patient satisfaction score after injury (TPSSI) was used to evaluate the patient satisfaction.

Results:

The mean age was 37.94 years (range: 18–72 years). They were followed-up for mean duration of 8.18 months (range: 6–13 months). Out of total 38, 23 underwent orthopedic trauma surgeries and rest 15 were managed nonoperatively. There was a mean delay in surgery of 5 weeks (range: 3–12 weeks). Five patients lost their lives and seven others had nonunion. The median TPSSI score was three.

Conclusions:

Nonoperative and delayed surgical management of adult orthopedic trauma patients, who tested positive for SARS-CoV-2 at admission, result adversely in activities of daily living and return to original occupation and, thus, have poor patient satisfaction.
Blockchain Technology in Healthcare
Authors: Kashyap Abhishek , Yadav Akash , Bajaj Vineet , Khan Yasim , Arora Sumit , Maini Lalit
Published: May 2024

Blockchain technology has recently been at the center stage of academic discussions. This is owing to its use in the financial sector and the rise of cryptocurrencies like Bitcoin. In essence, digital ledger technology (DLT) is shared digital data spread across multiple sites. A blockchain is a type of DLT consisting of a growing list of records, called blocks, securely linked with a time stamp. Maintaining data privacy and security is one of the core benefits of using the blockchain network. In healthcare, efficient data sharing is desirable with secure long-term access to data. In recent years, numerous applications built on blockchain infrastructure have been introduced in the healthcare sector. In this narrative review, we intend to introduce the science of blockchain technology, its core concepts, and its application to healthcare. We also describe current instances of its application in the healthcare sector, its application from the Indian perspective, and its limitations and future possibilities.
Sequential Fracture of Neck of Femur of Both Sides in a Patient with Psychosis
Authors: Sabat Dhananjaya , Kukreti Prerna
Published: May 2024

The authors describe the case of an adult male patient with psychosis developed fractures of neck femur of both sides sequentially at a year interval following trivial trauma. In addition, the patient was found to have hyperthyroidism. The rare presentation, possible complex etiopathogenesis for the problem and difficulties in treatment are discussed.
Artificial intelligence and healthcare
Authors: Mittal Akshit , Afsar Aiman Perween , Tayal Anish , Shetty Manu Kumar
Published: May 2024

Artificial intelligence (AI) is gradually changing the landscape of medicine. With the advent of powerful computation and the availability of “big data,” the applications of AI in healthcare are expanding to realms, which were previously thought to be the domain of human intelligence. The applications of AI could be broadly classified into diagnostic and therapeutic categories. The diagnostic applications of AI include the procurement of specimens and interpretation of the findings. Similarly, novel AI algorithms are being applied to analyze retinal images and radiographs. Further, the algorithms could classify patients into clinically relevant categories and aid in decision making. The therapeutic applications of AI extend from prescribing medicines to performing robotic- and endoscope-assisted surgeries, with precision nearly as high as that of trained surgeons. Other applications of AI are predicting epidemics, developing drugs, and managing intensive care units (ICUs), to name a few. AI holds unprecedented potential to revolutionize patient care. The knowledge of AI applications can help clinicians and researchers appraise the current state of the utilization of AI in healthcare and may guide future research. In this article, the existing and upcoming applications of AI in healthcare are reviewed, with respect to various disciplines.
Assessment and Comparison of the Mental Health Status of Patients Seeking Psychiatry Facilities in Pre-lockdown and Post-lockdown Period During COVID-19 Pandemic
Authors: Sharma Devesh , Garg Sunny , Sharma Anchal , Sharma Dinesh Dutt , Sharma Nidhi , Gupta Simran , Sharma Shivam
Published: May 2024

Background:

The servicing and framework for mental health care accessible to population have been affected during the unprecedented times of coronavirus disease (COVID-19) pandemic. The new and almost exclusive method to maintain a therapeutic alliance with these patients has been the recently evolving telepsychiatry services.

Aim and Objectives:

The main aim of the study was to assess and compare the mental health status of patients seeking available psychiatry facilities in pre-lockdown and post-lockdown period during COVID-19 pandemic.

Methodology:

This was a retrospective cross-sectional study that was conducted in a tertiary care hospital in a hilly region of North India. The registered data was analyzed between January 1, 2020 to March 21, 2020 to gather the information of patients about sociodemographic profile and clinical diagnosis on the basis of International Classification of Diseases-10. The retrieved data constituted 499 new consecutive patients during this period. Then in the post-lockdown phase after the resumption of OPD services in the institute (May 3, 2020), the data collection was initiated to collect a similar sample size of new consecutive patients (501). These data were collected over 151 days (May 3, 2020 to September 30, 2020).

Results:

A total number of 1000 patients were analyzed. Majority of the patients were male (66%) and within 19 to 60 years of age (85–90%). The average number of patients (3.31) seen per day was less and the average age of the patients (39.17 years, standard deviation = 14.37) was significantly higher in the post-lockdown phase. The most common diagnostic group consisted of neurotic/stress-related/somatoform disorders. As compared to the pre-lockdown period, a significantly (P < 0.001) lower number of patients diagnosed with substance use disorders and a significantly (P < 0.001) higher number of patients diagnosed with psychotic disorders along with anxiety disorders availed the available psychiatry services in the period of COVID-19 pandemic.

Conclusion:

Sudden cessation of the psychiatry services further precipitated the deterioration of mental health of the patients. There is an urgent demand for services to adapt to changing scenarios with emphasis on practical approaches to help the mentally ill people especially in geographically difficult hilly areas.
Effect of acute exercise on Cardiovascular and Serum cortisol reactivity to mental stress in offspring of hypertensives
Authors: Nigade Pooja Sardar , Varshney VP , Bedi Mona
Published: May 2024

Introduction:

The purpose of our study was to evaluate the effect of acute exercise on HR, BP and serum cortisol levels in offspring of hypertensives. This could serve as a preventive measure to habituate the high risk population group right at the early age.

Material and Methods:

The study was a double blind single centered randomized controlled prospective study conducted in the Department of Physiology & Biochemistry, Maulana Azad Medical College and associated hospitals, New Delhi over a period of 1 year. 30 subjects were recruited for the study. They were labelled as:- Group 1–the subjects were rested for 10 minutes after which the measurement of BP, HR and Serum cortisol was done. This resting value was labeled as R-1. The subjects were then exposed to mental arithmetic test (MAT) for 5 minutes. Thereafter their BP, HR and Serum Cortisol were measured again and labeled as T-1. Group 2–Same subjects were similarly rested for 10 minutes after which the measurement of BP, HR and S. cortisol was done. This resting value was labeled as R-2. This was followed by 20 minutes of Bicycle ergometry exercise. The subjects were then exposed to MAT for 5 minutes. Thereafter their BP, HR and Serum cortisol were measured again and labeled as T-2. We then compared (T2–R2) known as

Cardio-Adrenal Reactivity (CAR)

with exercise vs CAR without exercise (T1-R1). 2ml of blood sample was withdrawn for estimation S. cortisol. Paired t-test was applied for comparison (p value <0.05–significant).

Results:

The CAR was more in Group 1 compared to Group 2, difference being statistically significant.

Conclusion:

Study showed statistically significant change between with and without exercise groups. Acute exercise can reduce the adrenocortical reactivity to stress, a preventive tool for development of future hypertension.
Implementation of Team Teaching in Medical Colleges
Authors: Shrivastava Saurabh RamBihariLal , Shrivastava Prateek Saurabh
Published: May 2024

Acknowledging the complexity of medicine and the pressure on medical students in the current era, it is the need of the hour to ensure that they are taught using effective teaching-learning strategies. Team teaching refers to the approach wherein two or more qualified teachers join their hands together with an aim to provide knowledge to the students. The adoption of team teaching offers enormous benefits to the medical students, in terms of a broader range of experience, different teaching styles, views, and better problem-solving via the development of critical thinking skills. To conclude, the adoption of team teaching can prove to be an effective learning experience for the teachers and the students. However, to maximize the outcome, a significant amount of planning and coordination is required among the team members and thus all the medical colleges should aim to implement within their settings for the benefit of the medical students.
Pitfalls of Sanitizer Use in the COVID-19 Era
Authors: Aggarwal Sunita , Vijayakumar Sricharan , Singh Ranvijay , Koner Bidhan Chandra , Saijpaul Rajni , Kumar Naresh , Kumar Ankitesh , Mittal Tushar
Published: May 2024

The COVID-19 pandemic has boosted the availability of hand sanitizers worldwide, which have become ubiquitous. Their widespread utility has also contributed to increased accidental or intentional sanitizer ingestion. We describe the case of a young male who presented with an unintentional ingestion of hand sanitizer. On examination, he had a depressed sensorium, and further evaluation revealed severe metabolic acidosis. The patient was suspected of ethanol toxicity and underwent hemodialysis with concurrent bicarbonate replacement. However, the presence of bilateral visual loss, characteristic Computed Tomography (CT) brain finding of hemorrhagic putaminal necrosis, and normal serum ethanol levels prompted a search for methanol in the sanitizer. Specific biochemical tests confirmed this for methanol, and a diagnosis of sanitizer-induced methanol poisoning was made.
Justifying the Need and Exploring Learning Opportunities for Clinical Teaching to Medical Students in Ambulatory Settings
Authors: Shrivastava Saurabh RamBihariLal , Shrivastava Prateek Saurabh
Published: May 2024

As the ultimate aim of medical education is to produce a competent medical student who can meet the needs of the community they serve, the acquisition of clinical skills and other attributes carries immense importance in the training period. Keeping this in mind, the clinical teaching offered to the medical students is a crucial component of training and all efforts should be taken by the administrators and teachers to increase the number of opportunities available to medical students for teaching and learning. Owing to the changing dynamics in patient care, the ambulatory care settings end to neutralize all the limitations attributed to the ward teaching. In conclusion, clinical teaching in the field of medical education has gradually moved from the wards to the ambulatory settings. These settings precisely reflect the true spectrum of health and disease in the community and it is the need of the hour to expose the medical student to these wide ranges of learning opportunities and help them to become self-directed learners.
Correlation between Levels of Vitamin D and Disease Severity and Outcome in COVID 19 Patients at a Tertiary Hospital in North India
Authors: Ghosh Tamoghna , Krishnan Rahul , Chowdhury Souradeep , Kumar Arvind , Baitha Upendra , Sharma Shweta , Wig Naveet
Published: May 2024

Introduction:

COVID-19 disease is more prevalent and severe in people who are more likely to be deficient in vitamin D, people with obesity and diabetes mellitus, and people who live in higher latitudes.

Materials and methods:

The study was an ambispective, analytical, observational study conducted at a tertiary care teaching hospital in New Delhi, India. The study population consisted of adults with a confirmed diagnosis of COVID-19.

Results and conclusion:

Eighty eight patients diagnosed with COVID-19 between February and July 2021 were enrolled, with mean (SD) age being 40(2) years and there were 55 (62.5%) males. The most common co-morbidities were hypertension, diabetes mellitus, and chronic obstructive pulmonary disease (COPD) and the most common symptoms were fever, cough, and myalgia. Twelve (13.6%) patients had severe disease. Seven (7.9%) patients died. Sixty one (69.3%) patients had vitamin D levels <30 ng/mL and had severe disease, more symptoms, and increased oxygen requirement, but did not affect laboratory parameters and mortality.
Removal of Bullet from Infratemporal Fossa Through Endoscopic Approach
Authors: Meher Ravi , Wadhwa Vikram , Ali Mohamed Riyas , Ahmad Shafaat
Published: May 2024

Head and neck wounds account for a large majority of gunshot and firearm-related injuries. The morbidity and mortality associated with such injuries are high due to the presence of various vital structures in the vicinity, such as trachea, esophagus, carotid and vertebral artery, brachial plexus, and so on. Damage to any of these can lead to devastating results. However, in rare cases, there can be unusual trajectories of the bullet bypassing these structures. Here, we present one such case of a 35-year-old man where the bullet got lodged in the infratemporal fossa and it was successfully removed by trans-maxillary endoscopic approach. Transmaxillary endoscopic approach for infratemporal fossa is a minimally invasive technique with low morbidity, better acceptability, and quicker postoperative recovery than traditional approaches.
Use of TIVA as an Adjuvant to SAB in a COVID-19-positive Parturient with Morbid Obesity Posted for Emergency Caesarean Section − A Case Report
Authors: Gahlot Divya , Wadhwa Bharti , Saxena Kirti Nath
Published: May 2024

Obstetric patients offer specific anesthesia concerns and associated coronavirus disease 2019 (COVID-19) infection makes the condition more challenging. We describe anesthetic management and difficulties encountered in a parturient with multiple comorbid conditions who came for an emergency caesarean section (CS). A 32-year-old morbid obese COVID-positive female G2P1L1 at 36 weeks gestation with previous LSCS, gestational hypertension, and diabetes presented for emergency CS in view of fetal distress. She had a respiratory rate of 24 to 28/minute maintaining a saturation of 94% to 95% on oxygen at 6 to 8 L/minute. Airway examination revealed mouth opening = 2.5 cm, Mallampati classification III, neck circumference 40 cm, temporomandibular distance 3.5 cm. Surgical duration was unusually prolonged and was successfully managed with total intravenous anesthesia (TIVA) as an adjuvant to subarachnoid block. We successfully managed an emergency CS of a morbidly obese parturient with COVID-19 infection using TIVA as a rescue anesthesia to central neuraxial block, avoiding conversion to general anesthesia, minimizing aerosolization and associated risk.
Massive Hemoptysis in Post-Tubercular Sequelae
Authors: Gupta Neeraj Kumar , Kumar Rohit , Garg Puneet , Ish Pranav , Aggarwal Vipin , Gupta Nitesh
Published: May 2024

Massive hemoptysis can lead to respiratory failure and life-threatening hypoxia in patients with underlying post-tubercular fibrocavitary disease. In the absence of urgent surgical interventions in a resource-poor country, interventional bronchoscopy and bronchial artery embolization (BAE) can be lifesaving in critical care management of such patients. We present a young male who required mechanical ventilation, emergency bronchoscopic intervention, and BAE, and showed recovery.
Osmotic Demyelination Syndrome Presenting as Extrapontine Myelinolysis with or without Central Pontine Myelinolysis
Authors: Gupta Saurabh , Gupta Shikha , Shroti Akhilesh
Published: May 2024

Background and objective:

Osmotic demyelination syndrome (ODS) refers to a spectrum of clinicoradiologic syndrome which occurs due to pontine and extrapontine involvement due to myelinolysis. It is well described in association with rapid correction of hyponatremia and in alcoholics. In this case series, we have reviewed clinical presentation, neuroimaging features, and clinical outcomes of five patients diagnosed with ODS.

Methods:

The hospital medical records of all patients diagnosed with ODS between September 2018 and May 2020 at our hospital were analyzed retrospectively. Patients’ relevant clinical details and laboratory findings were recorded and magnetic resonance imaging (MRI brain) was reviewed. Those cases having imaging or clinical picture not clearly consistent with diagnosis were excluded.

Results:

Patients included in the study were 49 to 69 years old. All patients were treated as a case of hyponatremic encephalopathy in local hospitals. All patients had initial improvement followed by neurologic deterioration for which they were referred to our hospital. Possible etiologies of hyponatremia were recurrent vomiting and diuretic induced in two patients each and alcohol induced in one patient. Three out of five patients showed isolated extrapontine involvement on MRI. All patients showed improvement on dopaminergic drugs, whereas one patient had residual pseudobulbar symptoms which improved on follow-up.

Conclusion:

This series represents cases with clinical, etiopathogenic and radiologic spectrum of the ODS. ODS is a potentially treatable condition and rewarding results can be obtained by prompt diagnosis and management of associated secondary complications.
COVID-19 and Underlying Comorbidities
Authors: Lamba Manvi , Khurana Vatsala , Lamba Ginni , Goswami Binita
Published: May 2024

Context:

The world witnessed the emergence of a new disease, coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which is now a global pandemic. Studies have shown that people with pre-existing conditions are more vulnerable to the virus compared to people with no comorbidities.

Aims:

The present study has been conducted to evaluate the prevalence of comorbidities among patients with COVID-19 admitted to a district hospital in Sonipat, Haryana.

Materials and methods:

An epidemiologic, questionnaire-based cross-sectional study was conducted on consecutive patients with COVID-19 admitted to a civil hospital in Sonipat, Haryana between May 13, 2020 to November 13, 2020 over a period of 6 months.

Statistical analysis:

The data were analyzed using SPSS version 20.0 (IBM Corp., Armonk, New York, USA).

Results:

The results show that men (65.4%) were affected more than women with maximum prevalence in the age group of 21 to 30 years (28.8%). Only 10.7% of the volunteers showed no signs of any chronic ailment in contrast to 89.3% volunteers who were already suffering from some underlying health condition. The data also revealed that people suffering from type 2 diabetes (40.9%) and hypertension (33.5%) are more susceptible to develop SARS-CoV-2. About 55.9% of the participants were asymptomatic at presentation.

Conclusion:

People with chronic conditions were more susceptible to COVID-19, may be due to an increased inflammation leading to weakening of the immune system. As prevention is better than cure, so by following basic principles of sanitization, social distancing, and use of proper face masks, people with comorbidities can protect themselves from the virus.
Anesthetic Management in Pediatric Patient with Moyamoya Disease in Orthopaedic Surgery
Authors: Manohar Manisha , Wadhwa Bharti , Saxena Kirti N. , Gahlot Divya
Published: May 2024

A 12-year-old female, diagnosed case of Down phenotype with Moyamoya disease (MMD) was posted for internal fixation of compound fracture shaft of femur. Preanesthetic evaluation revealed history of acute URI, abnormal body movements, left hemiparesis and mental retardation. Patient was managed under general anesthesia with proseal LMA and caudal epidural was administered for adequate analgesia in the perioperative period. The goal of anaesthetic management in a case of MMD is to maintain the balance between cerebral metabolic oxygen consumption rate (CMRO2) and cerebral blood flow (CBF) in order to prevent any neurologic morbidity. Though there is no ideal anaesthetic agent in MMD, the anaesthetic technique should ensure normotension, normocapnia and normothermia in the perioperative period. To our knowledge regional analgesia has not been used in the pediatric orthopedic surgeries in patients diagnosed with Moya moya. The technique of general anaesthesia supplemented with caudal epidural analgesia ensures that all the anesthetic goals are met adequately and the precarious cerebral circulation in moya moya patient is not compromised.
A Study on Perception of Stress Among First-Year Medical Undergraduates During Covid-19 Pandemic
Authors: Khullar Shilpa , Das Suman , Rizvi S Aijaz Abbas , Sinha Praveena , Abidi Syed Sibte Akbar , Baisla Rahul
Published: May 2024

Background:

Medical students have been reported to suffer from a higher degree of perceived stress compared to the age-matched population doing other courses. Stress caused by the ongoing coronavirus disease (COVID-19) pandemic, lockdown, and the consequent shift of teaching methods to digital format has further compounded the stress associated with pursuing the medical curriculum.

Aims and Objectives:

Our study aimed to assess perceived stress among first-year MBBS students during COVID-19 induced lockdown using a self-administered Perceived Stress Scale (PSS-10) questionnaire.

Materials and Methods:

A total of 108 first-year MBBS students in the 18–25 years age group of both sexes were administered a 10-item questionnaire: PSS-10 during 2 months from June-July 2021and depending on their scores of PSS were divided into three groups Group A, B, and C signifying mild, moderate, and severe stress perceived by them, respectively. The continuous variables are presented as mean ± standard deviation and the categorical variables as proportions. Analysis of Variance (ANOVA) was used to compare the data between continuous variables in the three groups.

Result:

There was a statistically significant difference in the PSS scores between the three groups when a comparison was done (P < 0.05). A larger segment of the first-year medical students undergoing medical curriculum during the COVID-19 pandemic were found to be moderately (63%) to severely (4%) stressed.

Conclusion:

Our study suggested that the stress induced by the pandemic in addition to the stressors associated with undertaking medical courses creates a highly stressful environment for the medical students predisposing them to significant psychological morbidity.
Psychological Impact of Covid-19 Pandemic on Healthcare Workers Posted in the Obstetric Unit
Authors: Chadha Shikha , Prasad Sonal , Tyagi Dinesh , Ansari Aaliya , Kahar Govind R
Published: May 2024

Objective:

This study was done to determine the prevalence and predictors of depression, anxiety, and stress among doctors in COVID MCH unit in Delhi.

Method:

A cross-sectional study was conducted in India among 356 doctors to evaluate the mental health of doctors working in COVID-infected maternity wards over a period of 6 months using a predesigned, semistructured Depression, Anxiety, and Stress Scale (DASS-21) questionnaire which was developed on Google Forms. The predictors to stress, anxiety, and depression were subject to univariate logistic regression.

Result:

Out of the total 356 participants, 38.76% felt stressed, 56.46% were anxious, while 43.25% felt depressed. The mean DASS-21 score for stress, anxiety, and depression was 7.46, 4.12, and 4.29, respectively. Female gender was found to be a significant predictor of stress, anxiety, and depression. Staying with parents/children was a significant predictor for stress and living alone was found to be a significant predictor of depression. Fear of infecting their family members was the main concern among those tested positive.

Conclusion:

The present study has shown a significant psychological impact arising from this pandemic. Early screening targeting the medical workforce and the implementation of psychological interventions is essential for maintaining the functionality of the healthcare system.
Pharmacovigilance Activities in Maulana Azad Medical College and Associated Hospitals
Authors: Roy Vandana , Tayal Vandana , Haque Ijasul , Ahmad Jamshed , Verma Kavita , Singh Virendra
Published: May 2024

Introduction:

Pharmacovigilance plays an important role in patient safety and rationalizing the use of medicines. It helps in identifying the frequency of adverse drug reactions (ADRs), their causes, and the associated risk factors. Pharmacovigilance activities are facilitated through adverse drug reactions monitoring centers (AMCs) in most of the institutions.

Aim:

The objective of this paper is to provide an overview to the health care professionals regarding ADRs reported from the associated hospitals of Maulana Azad Medical College (MAMC) and the pharmacovigilance activities undertaken.

Observations:

Maulana Azad Medical College, Department of Pharmacology was recognized as an AMC in 2014 under the Pharmacovigilance Program of India (PvPI). The AMC established a way for reporting ADRs both by spontaneously and through active monitoring of ADRs from different wards. The causality assessment of all ADR reports collected is done. The program was informed by a college pharmacovigilance committee, emails, and by putting posters in the hospital nursing stations. Fourteen training workshops for doctors and pharmacists and two training workshops exclusively for nurses have been conducted so far on pharmacovigilance. In 2017, a program to sensitize doctors working in the Delhi government hospital was started. A total of 854 healthcare workers have been sensitized. The center has reported a total of 2572 ADRs to the National Coordination Centre (NCC) at Indian Pharmacopoeia Commission until December 2021. ADRs reported were highest in the age group of 20 to 59 years. Most of the reports were from the department of T.B. and Chest (n = 589, 23.8%). The most common class of medicines implicated in causing ADRs was antimicrobials (n = 1100, 44%). Among the ADRs reported, the majority were mild (n = 1451, 81.1%) with 346 (18.8%) reported as serious.

Conclusion:

A system for reporting ADRs on campus has been established. The pattern of ADRs reported to this ADR monitoring center is comparable to the national and global data. Hospital-based ADR monitoring and reporting programs are very crucial to identify and quantify the risks associated with the use of medicines. The pharmacovigilance program at MAMC is a commitment and a small step towards patient safety.
Tracking Annual Antimicrobial Resistance at a Tertiary Care Hospital amidst Raging COVID-19 Pandemic
Authors: Saxena Sonal , Aggarwal Prabhav
Published: May 2024

Background:

Timely preparation and presentation of the annual cumulative antibiogram play an important role in the dissemination of an updated susceptibility pattern to clinicians and thus aid in the appropriate choice of antimicrobials for empirical therapy while minimizing adverse effects and resistance. The study aimed to present and analyze the annual AMR data that may be helpful in designing antibiotic policy.

Methods:

All clinical specimens routinely submitted to the Department of Microbiology from January to December 2021 for bacteriological culture and antimicrobial susceptibility testing (AST) were included. AST was performed for pathogenic isolates by disc diffusion/agar dilution/broth microdilution methods/VITEK® 2 compact system. All data were entered and analyzed using WHONET 2020 software.

Results:

A total of 46,629 routine specimens were processed, yielding 5792 non-repeat bacterial isolates. Relatively fewer specimens were received during the first few months when the hospital catered exclusively to COVID-19 patients. The most common bacterial isolates wereEscherichiacoli(30%),Staphylococcus aureus(21%),Klebsiella sp. (18%),Pseudomonas sp. (10%),Acinetobacter sp.(8%) andEnterococcus sp.(5%). Analysis showed low susceptibility to 3rd generation cephalosporins, fluroquinolones, and cotrimoxazole among Gram negative bacteria. Less than 50% Acinetobacter sp. were carbapenem susceptible. We report high rate of methicillin resistance inS. aureus(74%). Overall susceptibility was much lower in specimens from ICU followed by in-patients and out-patients.

Conclusion:

Antimicrobial resistance is rapidly assuming the proportions of a pandemic, with several authors calling it “invisible” pandemic. As is evident from the present study, low susceptibilities to all but a few last-resort drugs are leaving few choices for treatment. This mandates effective preparation, distribution, and presentation of annual antibiograms, which will help in formulating hospital antibiotic policy.
Acute Influence of Moderate Exercise on Smoking Urge, Mood, and Physical Withdrawal Symptoms
Authors: Singh Saurabh Kumar , Jain Preeti
Published: May 2024

Background and Objectives:

The potential role of exercise as an aid to conventional smoking-cessation measures is being increasingly suggested. The present study was conducted with the aim of assessing and comparing the influence of short-duration, moderate-intensity exercise on the urge to smoke, and mood and physical withdrawal symptoms among male smokers following an overnight temporary abstinence from smoking with those who smoked ad-libitum.

Methods:

Thirty male smokers between 18 and 45 years, who smoked >10 cigarettes/day for >1 year were recruited and randomized into two different groups (n = 15 in each group). The abstinent group included smokers who had at least 10 hours of overnight temporary abstinence from smoking on test day. The non-abstinent group included smokers who smoked ad libitum without having any temporary abstinence from smoking on test day. Nicotine dependence, smoking-urge, and withdrawal symptoms were assessed using the Fagerström test for nicotine dependence (FTND), brief questionnaire on smoking-urge (QSU-Brief), and the mood and physical symptom scale (MPSS), respectively. All subjects in both groups performed moderate-intensity exercise on a friction-type bicycle-ergometer at a fixed frictional force of 2 kg for 5 minutes at 40-60% of heart-rate reserve. QSU-Brief and MPSS were assessed pre-exercise and post-exercise (immediately, 5 and 10 minutes after stoppage of exercise).

Results:

QSU-brief and MPSS scores were comparable in both groups at all time points (P > 0.05). There was a significant decline (P < 0.001) in QSU-brief and MPSS scores immediately following exercise in both groups, which persisted after 5 (P < 0.001) and 10 minutes post-exercise (P < 0.01).

Interpretation and Conclusions:

Our results indicate that a single session of short-duration, moderate-intensity exercise effectively alleviated the smoking urge and negative effects of nicotine withdrawal symptoms in both study groups and led to an overall improvement in their mood. The results further indicated that these beneficial roles of exercise persisted even after a 10 minutes of stoppage of physical activity. We recommend the incorporation of a brief session of moderate exercise as a smoking cessation aid to provide additive relief from cigarette cravings and nicotine withdrawal symptoms in smokers attempting to quit.
Post-Suxamethonium Muscle Pains after Vitamin C Pretreatment
Authors: Gupta Lalit , Dwivedi Gaurav , Choudhary Kapil
Published: May 2024

Background:

Succinylcholine has been extensively used for endotracheal intubation because of its ultrashort duration of action, quick onset with complete and predictable paralysis. However, the occurrence of some side effects like post injection fasciculations, postoperative myalgia, and increase in serum potassium levels limits its use in some situations like burns, myopathies, and myoglobinuria. For attenuation of these effects, many drugs have been studied but with limited success.

Aims and objectives:

To evaluate the role of vitamin C on attenuation of post-suxamethonium myalgia and increase in serum potassium levels.

Materials and methods:

Seventy-five females of American Society of Anaesthesiologists grade I and II and aged 20 to 50 years undergoing general anesthesia for various short surgical procedures were randomly allocated into three groups. Induction of anesthesia was performed with injection thiopentone 5 mg/kg body weight and suxamethonium 50 mg in all three groups. In group I, no drug was administered before induction of anesthesia. In group II, 500 mg tablet of vitamin C was administered twice orally a day before and on the day of surgery half an hour before induction of anesthesia. In group III, vitamin C 500 mg was administered intravenously in 50 ml saline half an hour before induction of anesthesia. The absence or presence of muscle pains and fasciculations were noted and if present, then their severity was also estimated. Serum potassium levels were measured in the venous samples collected just before induction and at 5-minute interval after the administration of suxamethonium. Patients were observed for myalgia on postoperative days 1, 2, and 3.

Results:

The patients receiving vitamin C had a little reduction in the incidents but marked reduction in severity of muscle pains and fasciculation. Furthermore, the administration of vitamin C markedly delayed the onset of muscle pains. There was no effect of vitamin C pretreatment on serum potassium levels.

Conclusion:

Pretreatment with vitamin C 500 mg may be useful in reduction of severity of post- suxamethonium myalgia.