bluuebunny/crossref_metadata_2025 huggingface dataset:
A Cadaveric Study On Clinical Correlations of the Internal Jugular Vein and its Variations
Authors: Maniyar Roshan Zameer , Deshmukh Sandeep S. , Vrushali K. , Meenakshi P N
Published: April 2024

Introduction:

The largest paired vein is the internal jugular vein (IJV), which rests laterally adjacent to the main the common carotid artery (CCA) within the carotid triangle at the extremities of the neck. It is the main source of blood flow down from the sigmoid sinus of dural venous sinuses. The obstruction of blood flow or distension of the internal jugular vein can lead to increasing intracranial pressure in the brain and face. The increased the right atrial pressure can be a sign of heart failure, cardiovascular problems, and pulmonary embolism. The aims are to study and note down variations in the course and relations of the internal jugular vein and variations of tributaries of right IJV and left IJV diameter and effects on cardiovascular diseases.

Materials and Methods:

An observational based cadaveric study was conducted on twenty-four unclaimed embalmed cadavers were dissected from March 2021 to August 2023 in Bidar Institute of Medical Sciences, Bidar, Karnataka, India. Dissection procedure was followed by Cunningham’s manual of practical anatomy volume-3 book. Variations and pattern of bilateral internal jugular veins were observed.

Results:

External jugular vein access is a highly advantageous location for a heart catheterization. The tributaries of the internal jugular vein form the trunk and overlap on the common carotid artery bifurcation, which leads to adverse effects on baroreceptors and chemoreceptors at the level of divisions of internal and external carotid arteries. The pattern of the right and left internal jugular is quite significant.

Conclusion:

The study will generate information that would be useful for surgeons, and other clinical physicians and give necessary morphometric data on the internal jugular vein in the South Indian population.
Kikuchi–Fujimoto Disease in a Young Male with Fever Postvascular Surgery
Authors: Kumar Rahul , Khosla Pooja , Taneja Vinus , Dessai Rishikesh , Sondhi Manuj
Published: April 2024

Kikuchi–Fujimoto disease is a rare self-limiting necrotizing lymphadenitis usually affecting young adults. It commonly presents with tender posterior cervical lymphadenopathy and fever. Infections and autoimmune disorders are considered triggers for the onset of Kikuchi’s disease. However, the exact pathogenesis of the disease remains unclear. We report a case of a young male who underwent surgery for anomalous origin of the thoracic arteries post which he developed a persistent fever and cough. He was hemodynamically stable with no localizing signs of fever. All infective workups were negative. After an intensive workup, he was finally diagnosed with Kikuchi–Fujimoto disease.
Hereditary Angioedema- A Rare Case Report and Literature Review
Authors: Neeradi Charan , Jain Vishakha , Reddy Janaradhan P. , Reddy Sugunakar , Priya Ilakkiya
Published: April 2024

Hereditary angioedema (HAE) is a rare disorder due to either deficiency or dysfunction of Complement 1 (C1) esterase inhibitor (C1-INH). HAE usually presents with recurrent angioedema (AE) episodes affecting the extremities, face, and gastrointestinal tract, but it is not associated with urticarial rash and itching. Timely identification of this condition is vital because the lack of response to traditional antihistamines and steroids leads to a rise in mortality of up to 30%–40% in undiagnosed cases. Here, we present a case involving a 25-year-old woman, who presented with 1-day complaints of right upper limb swelling, which spread to involve all the limbs and her face within 12 h of symptom onset. She also had a history of abdominal pain, which was sudden in onset, squeezing type, without any associated vomiting and diarrhea. She denied a history of drug or food allergies. Given the presence of AE, we treated her with antihistamines and steroid injections, but she failed to respond. On asking, she gave a history from childhood of repeated episodes and similar complaints in her family members. With history and physical symptoms suggestive of HAE, diagnostic studies showed decreased complement 4 l (C4) and C1 INH levels, confirming the diagnosis of HAE Type 1. The patient was successfully managed with fresh-frozen plasma as first-line treatment options are unavailable in India. Due to a lack of clinical awareness, the disease often remains undiagnosed for several years. Thus, there is a high need to raise clinical awareness and diagnostic facilities to improve case detection and management of HAE.
Human Leukocyte Antigen-B51 Association and Behcet’s Disease in Saudi Arabia
Authors: Qushmaq Khalid A. , Albirdisi Majed R. , AlAsiri Mohannad M. , Andijani Ahmad I. , AlJurayyan Abdullah
Published: April 2024

Introduction:

Behcet’s disease (BD) is a chronic systemic inflammatory vasculitis of unknown etiology, characterized by recurrent oral ulcers, genital ulcers, skin lesions, ocular lesions, and other systemic manifestations. The pathogenesis of BD is unclear. Multiple studies have suggested close correlation between BD and human leukocyte antigen-B51 (HLA-B51) as a genetic factor. In our study, we aim to identify the association of HLA-B51 as a risk factor and its association with the multiple clinical signs and symptoms of Saudi BD patients in the kingdom of Saudi Arabia.

Materials and Methods:

A retrospective study was conducted at a tertiary treatment center in the rheumatology subspecialty clinics, Riyadh, Saudi Arabia, from 2013 to 2018. The study was conducted by searching the hospital database for BD and HLA-B51.

Results:

HLA-B51 positivity was observed in 20 of the 38 patients in our sample, accounting for about a quarter of the total (52.6%).

Conclusion:

Our retrospective study found that HLA-B51 was positive in 52.6% of Saudi patients attending a single tertiary care center. However, a larger multicenter study is required to validate these observational data.
Glycated hemoglobin as a predictor for gestational diabetes
Authors: Emam Rania Mostafa , Nassef Aziza H. , Abou-Raia Hanaa
Published: April 2024

Background

Gestational diabetes mellitus (GDM) may cause fetomaternal complications. GDM can be diagnosed conventionally by an oral glucose tolerance test (OGTT). Glycated hemoglobin (HbA1c) is a marker for the blood glucose level in the previous 2–3 months.

Objective

The aim was to assess the role of using HbA1c as a predictor for developing gestational diabetes in the second trimester.

Patients and methods

Fifty pregnant women were investigated by ultrasound, and HbA1c and OGTT were performed for all cases at 18–22 weeks of gestation and repeated at 32–36 weeks of gestation.

Results

There were statistically significant differences between women with HbA1c value less than 5.7% and those with 5.7–6.4% according to BMI, parity, and maternal weight. A positive correlation was detected between HbA1c level and development of GDM according to OGTT, which was done in the third trimester, as women with HbA1c values less than 5.7% have decreased risks of developing GDM than women with higher levels of HbA1c. Follow-up of all cases detected significant relation between level of HbA1c and neonatal birth weight, neonatal ICU admission, and APGAR score, where the pregnant women whose HbA1c less than 5.7% got infant with less birth weight and better APGAR score and the incidence of neonatal ICU admission was less in their infants.

Conclusion

HbA1c can be used to predict the development of GDM in second trimester. Receiver operating characteristic curve identified that the best cutoff value of HbA1c was 5.2%, with sensitivity of 75%, specificity of 80%, positive predictive value of 71.4%, negative predictive value of 82.8%, with accuracy of 87.2% for diagnosing GDM.
Comparison of corneal changes after phacoemulsification in diabetic and nondiabetic eyes
Authors: Elminshawy Asmaa Ibrahim , Hegazy Hanan Saied , Aly Mona Mohamad
Published: April 2024

Background and aim

Endothelium of the cornea is susceptible to surgical trauma during phacoemulsification from ultrasound energy. Several studies have reported various results of corneal changes after phacoemulsification in diabetic and healthy patients. The aim was to evaluate and compare changes in precorneal tear film, anterior and posterior corneal surfaces, endothelial cell changes, and central corneal thickness (CCT) between diabetic and healthy patients before and after uneventful phacoemulsification.

Patients and methods

A total of 40 eyes of 40 patients who were scheduled for cataract surgery were divided into group 1 (20 eyes in nondiabetic patients) and group 2 (20 eyes in diabetic patients). Ophthalmological examinations, including uncorrected and best-corrected visual acuity (BCVA), slit lamp to examine anterior and posterior corneal surfaces, tear film breakup time test (TBUT), anterior chamber depth by IOL Master (Topcon ALADDIN HW2.0), and specular microscopy (Topcon SP-1P, made In Japan), were done preoperatively and at 1 week, 1 month, and 3 months postoperatively.

Results

Significant differences were found between preoperative and postoperative periods in both groups regarding BCVA, TBUT, CCT, endothelial cell density (ECD), coefficient of variation, and hexagonal cells, except that changes became insignificant with respect to CCT at 3 months in nondiabetic and at 1 week and 3 months in diabetic and in CD at 1 month in healthy patients.

Conclusion

There were significant changes in BCVA, TBUT, CCT, and ECD after phacoemulsification in the diabetic and healthy groups. There was a significant delay in the recovery of CCT 1 month after phacoemulsification in the diabetic compared with healthy individuals.
Blood monocyte subtypes in patients with pulmonary tuberculosis infection
Authors: El-Rab Attia Tamer G. , Abdelmeguid Mona M. , Mohammed Ali S. , Fayed Hamada K.S.
Published: April 2024

Background and aim

Monocytes are the primary target for Mycobacterium tuberculosis infection. Important alterations in the proportions of circulating monocyte subpopulations were found in patients with active tuberculosis (aTB). Our aim was to investigate the peripheral blood monocyte subsets in patients with active pulmonary tuberculosis (aPTB) and to evaluate their role in treatment response.

Patients and methods

A case–control study included 30 patients with aPTB and 30 healthy controls. Laboratory investigations include sputum examination, tuberculin test, and nucleic acid amplification test using GeneXpert MTB/RIF assay on sputum sample for patients only to confirm the diagnosis of aPTB. For all participants; complete blood count, erythrocyte-sedimentation rate, HIV antibodies, and flow cytometry analysis of peripheral blood monocyte subsets were done using surface markers CD14 phycoerythrin cyanin 7 and CD16 fluoroisothiocyanate for identification of monocyte subsets. Flow cytometry analysis was repeated 2 months after the start of treatment in aTB patients only.

Results

Classical monocytes were decreased while intermediate, and nonclassical monocytes were increased in aTB patients before treatment more than after 2 months of treatment and control group (P≤0.0001 for each). There was no significant difference in the three monocyte subsets between PTB patients after treatment and healthy controls. Also, the classical monocytes decreased while intermediate, and nonclassical monocytes increased in aTB patients with positive tuberculin test more than healthy controls with positive tuberculin test (P<0.0001 for each).

Conclusion

The expansion of CD16+ monocytes was reversed after treatment with anti-TB drugs and could be used to follow up tuberculous patients for treatment effectiveness.
Restoration of natural killer cell activity in chronic hepatitis C-infected Egyptian patients treated by sofosbuvir/daclatasvir with or without ribavirin
Authors: Moustafa Hamdy M. , Abdel-Gawad Muhammad , Salaheldin Eman M. , Ibrahim Nagat F.S.
Published: April 2024

Background and aim

Numerous studies demonstrate natural killer (NK) cell dysfunction in hepatitis C virus (HCV) infection. Direct-acting antivirals (DAAs) can change NK cell activation when HCV replication is inhibited. Only few studies have reported the effect of DAAs on NK cells, especially in genotype 4. Therefore, our study aimed to examine the effect of elimination of HCV by DAA therapy on NK activity in chronic hepatitis C-infected patients.

Patients and methods

A prospective cohort study was conducted on 50 Egyptian naïve chronic hepatitis C-infected patients. The patients were treated with sofosbuvir/daclatasvir±ribavirin for 12 weeks, and NK cells were detected at baseline and at 12 weeks after the end of the treatment by multicolor flow cytometry.

Results

Overall, 98% of studied patients achieved sustained virological response (SVR) 12. One patient did not achieve SVR 12; this patient was given a second course of treatment with sofosbuvir (ombitasvir/paritaprevir/ritonavir) and ribavirin for 12 weeks and successfully achieved SVR. Therefore, SVR 24 of studied patients was 100%, and there was a significant increase in cluster of differentiation 16+ cluster of differentiation 56+ after treatment compared with pretreatment data (P=0.000).

Conclusion

Elimination of HCV infection by DAA therapy can restore the frequency of NK cells of chronic hepatitis C-infected patients.
Carotid intima-media thickness as an indicator of subclinical atherosclerosis in systemic lupus erythematosus patients
Authors: Abozeid Asmaa A. , Hazem Mohammed , Altaher Ali M. , Abda Essam A. , Elsayed Sahar A.
Published: April 2024

Background and aim

Accelerated atherosclerosis is a leading cause of increased cardiovascular morbidity and mortality in patients with systemic lupus erythematosus (SLE). Atherosclerosis is mediated by multifactorial processes including inflammation, endothelial dysfunction, autoantibodies, dyslipidemia, and traditional risk factors. So, we aimed to evaluate carotid intima-media thickness (CIMT) for early detection of subclinical atherosclerosis in patients with SLE and to determine its correlation with disease activity.

Patients and methods

A total of 50 patients with SLE and 50 healthy controls were included in this study. Full detailed history, clinical examination, and laboratory findings for all the participants were recorded. ECG was done for the patients and controls for the detection of QT dispersion. CIMT was measured bilaterally at the distal common carotid artery.

Results

On measuring CIMT, we found thickened CIMT (>0.8 mm) in 28% and plaques in 18% of the patients. There was a highly significant increase in the right CIMT, left CIMT, and mean CIMT of both sides in the patients in comparison with the controls (P<0.0001, P=0.004, and P<0.0001, respectively). The ECG findings showed that 40% of our patients had normal ECG, 10% had abnormal ST segment, 34% had sinus tachycardia, and 16% had QT dispersion. Moreover, CIMT was positively correlated with SLE disease activity index (SLEDAI) and associated with other nontraditional risk factors including age, disease duration, anti-dsDNA, C3, and nephritis.

Conclusion

Premature atherosclerosis is a devastating health problem in patients with SLE, which may be accelerated by multiple risk factors related to the disease process and medications; hence, early detection of subclinical atherosclerosis through the measurement of CIMT using carotid ultrasonography is a reliable noninvasive technique to allow early therapeutic intervention and to reduce the mortality.
Lung ultrasound for detection of pneumonic changes in patients with COVID-19 infection
Authors: Ati Moaz A.E.S.A. , El Deeb Ahmed M. , Shahin Mohamed A.A. , Kabil Ahmed E.
Published: April 2024

Background and Aim

Given the pandemic crisis of COVID-19 pneumonia, the computed tomography (CT) chest is widely used for initial management of patients with suspected COVID-19 because of its well-known high sensitivity for detection of COVID-19 pneumonia, but its cost, which decreases its availability for certain populations, risk of radiation, need for transportation of the patient, the burden of proper disinfection of the CT room and its unsuitability for some patients like pregnant and lactating women certainly lead to the necessity for a more advantageous tool like lung ultrasound that could solve many of the previous obstacles encountered while deciding to perform the CT chest. This study aims to determine the suitability of lung ultrasound as an alternative to CT chest to aid in the initial management of these patients. The aim was to determine the value of lung ultrasound in the diagnosis of lung parenchymal affection in patients with COVID-19.

Patients and methods

A prospective including 150 patients was carried out in the Chest, Interventional Radiology and Clinical Pathology Departments in Bab-El-Sha'aria and Al-Hussin Hospitals, Al-Azhar University, during the period from May 2020 to September 2020. Lung ultrasound was performed in 150 patients with COVID-19 pneumonia diagnosed based on the integrated clinical, laboratory, and CT chest radiological data.

Results

Among 150 patients, there were 86 males and 64 males, ranging in age from 30 to 75 years and a mean age of 55.8±12.1 years. Bilateral lung infiltrates in the CT scan were present in 146 patients (97.3%), CXR infiltrates were present in 63 patients (42%), sonographic evidence of pleuropulmonary involvement was present in 139 patients (92.7%), B lines and pleural line thickening were present in all patients with ultrasound findings (100%), subpleural consolidation associated with B lines was present only in 33 patients (23.7%) and pleural effusion was absent in all cases; crackles were only present in 53 (35.3%) patients.

Conclusion

Because of its simplicity in interpretation, bedside availability, lack of risk of radiation and good sensitivity in the detection of lung parenchymal affection, the chest ultrasound is a useful tool in the management of patients with symptoms suspicious of COVID-19 infection and seems to be a suitable substitute for the CT chest in such circumstances.
Treatment of corneal astigmatism by limbal relaxing incisions during phacoemulsification surgery
Authors: Naguib Maged A. , Elrashidy Hussam E. , Samir Ghada
Published: April 2024

Background and aim

The aim was to assess the effectiveness of limbal relaxing incisions (LRIs) in treatment of astigmatism in patients undergoing phacoemulsification surgeries.

Patients and methods

Forty-eight eyes of 48 patients suffering from senile cataracts of mean age 64.7±7.9 (range: 50–77) years, and mean corneal astigmatism 1.8±0.73 diopters (D) (range: 1.5–3.5 D) were included in this study. All LRIs were performed at the end of phacoemulsification. Corneal topography results were compared before surgeries and 2 and 6 months after surgeries.

Results

A statistically significant reduction in the mean corneal astigmatism was seen from 1.8±0.73 D (range: 1.50–3.50) preoperatively to 1.1±0.24 D (range: 0.5–1.7) and 1.4±0.52 D (range: 0.60–1.9) in the second and sixth postoperative months, respectively (P<0.001). Surgical-induced astigmatism (the amount and axis of astigmatism change induced by surgery) was 0.90±0.48 at 2 months and 0.96±0.59 at 6 months. Correction index (calculated by determining the ratio of surgical-induced astigmatism/target-induced astigmatism) was 0.56±0.42 and 0.57±0.33 at 2 and 6 months, respectively. Index of success (ratio of topographic residual astigmatism and target-induced astigmatism) was measured to be 0.45±0.42 and 0.48±0.33 at months 2 and 6 correspondingly.

Conclusion

Combined LRI and phacoemulsification appears to be safe and fairly effective to correct mild-to-moderate corneal astigmatism. However, undercorrection is a common limitation that may be further managed by modified nomograms in future studies.
Mean platelet volume (MPV) as a biomarker of disease activity in ulcerative colitis
Authors: Mohammed Nashaat Y. , Eid Khaled A. , Mohammad Ahmed Q.
Published: April 2024

Background and aim

All platelet indices may be useful biomarkers for follow-up in inflammatory bowel disease patients as they show a strong correlation with disease activity. In this work, we aimed to investigate the relation between mean platelet volume (MPV) and ulcerative colitis (UC) activity by comparing the MPV values between cases with active UC, mild cases and normal individuals.

Patients and methods

This observational study was carried out on 90 individuals aged >18 years. They were divided equally into the following groups: group A: active UC, group B: remitting UC and group C: healthy controls free of any systemic diseases as a reference. UC was confirmed based on colonoscopy and biopsy.

Results

Patients with active UC have significantly smaller MPV in comparison with patients with disease remission or healthy controls (P value <0.001), without a difference between patients in remission and healthy controls. MPV was directly proportional to the Hemoglobin level among study populations (r=0.64, P<0.001). MPV was negatively correlated with erythrocyte sedimentation rate (r=−0.74, P<0.001), total leukocytic count (r=−0.49, P<0.001) and platelet count (r=−0.24, P=0.023) in all the study populations.

Conclusion

MPV decreases in the active phase of UC compared with the remission phase or healthy individuals. There is a relationship between the degree of disease activity and MPV in UC. Hence, MPV can be a useful biomarker for assessing disease activity for UC.
Role of vitamin D in children with otitis media with effusion
Authors: Mohammed Ghada A. , Rashed Rashida A.A. , Elsayed Asmaa F. , Mostafa Soad Y.
Published: April 2024

Background and aim

Otitis media with effusion (OME) is characterized by retention of fluid behind an intact tympanic membrane. The association of vitamin D deficiency, upper respiratory tract infections, and otitis media has been reported by several studies. Aim: The aim was to investigate the relationship between OME and vitamin D level in children.

Patients and methods

This study is a case–control study that was carried out at Otorhinolaryngology and Pediatric Clinics at Al-Azhar University for Girls and Al Mataria General Hospital. In this study, 40 children were included, 20 children were controls and 20 children were diagnosed with OME (cases). Patients were subjected to history, otoscopic examination, and audiological evaluation (pure-tone audiometry and tympanometry). Blood samples (5 cm) were taken from case and control groups in the laboratory to measure serum 25-hydroxy vitamin D level.

Results

In the case group, mean vitamin D level was 17.02 ng/ml, SD±8.49, and the median was 14.90 (8.7–35.0) ng/ml. In the control group, mean vitamin D level was 25.85 ng/ml, SD±8.94, and the median was 30.20 (9.8–36.1) ng/ml with P significance equal to 0.007. Sixteen children (80%) out of 20 children of the case group and eight children (40%) out of 20 children of the control group had an abnormal value of vitamin D. An abnormal value of vitamin D was statistically significant in children with OME than the control group with P significance equal to 0.03.

Conclusion

It was found that vitamin D plays an important role in OME in our children and can share in the regimen of treatment of OME when it was found abnormal. Measuring vitamin D level in the case group is necessary and must be treated if abnormal.
Effect of treatment with hydroxyurea on calcium homeostasis in β-thalassemia-major patients
Authors: Hassan Khaled H.
Published: April 2024

Background and aim

Thalassemia is a chronic illness that has a range of serious clinical and psychological effects, it does not only affect the physical functioning of patients but also their emotional and social functioning and school functionings, leading to impairment of health-related quality of life of the patients due to the effects of the disease and its treatment. The aim of this study was to assess the effect of treatment with hydroxyurea on calcium homeostasis in β-thalassemia-major patients.

Patients and methods

This study is a prospective, case–control one, it was done on 50 patients with β-thalassemia major who received regular blood transfusion at Luxor International Hospital [25 patients received hydroxyurea (group II) and 25 patients did not receive hydroxyurea (group I)] and 25 apparently healthy children as controls.

Results

Group II (received hydroxyurea) had better results than group I (not received hydroxyurea) regarding the frequency of blood transfusion, manifestations of hypocalcemia (tetany, convulsions, and carpopedal spasm), and the occurrence of the boneache and bone fractures. Group II (received hydroxyurea) had better hemoglobin levels as well as other complete blood count parameters than group I (not received hydroxyurea). Group II (received hydroxyurea) had better results regarding serum-ionized calcium as well as serum ferritin, serum alkaline phosphatase, and serum phosphorus levels than group I (not received hydroxyurea).

Conclusion

Disturbed calcium homeostasis is one of these iron-overload hazards; it has different clinical and laboratory manifestations that can be improved by using the hydroxyurea therapy in the management of β-thalassemia patients.
Comparative study between primary closure, reconstruction flap, and a 1470-nm diode laser for pilonidal sinus surgery
Authors: Hassan Ahmed M. , Khalaf Adel M.
Published: April 2024

Background and Aim

Pilonidal sinus disease (PD) affects youngsters and is more recorded in males. Although a wide variety of treatment modalities to manage this disorder are still in use in everyday surgical practice, nevertheless, there was no consensus to which of those procedures is closer to perfect in providing definitive management. With recent advances in surgery, application of the laser was found to be an effective approach in the treatment of PD. The aim was to compare the outcome of management of PD by excision andprimary closure, excision and reconstruction by flap, and a 1470-nm diode laser, and to analyze its effectiveness, postoperative complications, recurrence rate, and satisfaction of the patient.

Patients and methods

This prospective comparative study between three methods of treatment of pilonidal sinus was made. This study includes 45 cases presented with PD disease: they are divided randomly into three groups. Group A (15 patients) was subjected to pilonidal excision and primary direct closure, while group B (15 patients) was subjected to pilonidal excision and local flap reconstruction, and group C (15 patients) was subjected to a 1470-nm diode laser.

Results

A significant difference was found to be between three groups regarding the duration of surgical procedures (in minutes). As regards to diode laser, all 15 cases had been managed efficiently on an outpatient procedure. Only one recurrent case was recorded.

Conclusion

Laser pilonidotomy is effective in the treatment of PD with a high rate of success, less complications, and high satisfaction of the patient.
Postoperative pulmonary embolism, risk factors, and medical thromboprophylaxis
Authors: Sobh Eman , Abdel Wahab Maisa A. , Adawy Zeinab R. , Abdelgalil Heba M. , Saleh Ola I. , Zakaria Doaa M. , Elshahat Randa S.
Published: April 2024

Background and aim

The major surgical procedures have a significant risk of venous thromboembolism (VTE), especially pulmonary embolism (PE), leading to poor prognosis and life-threatening conditions. The major surgical procedure has 20-fold risk increase in VTE and the risk is increased by 30% in the absence of optimal prophylaxis. This study aimed to estimate the incidence of PE among surgical patients undergoing preoperative thromboprophylaxis according to Caprini score, these considerations can improve the clinical outcome and allow optimal use of thromboprophylactic strategies against VTE.

Patients and methods

We performed retrospective analysis of records of patients admitted to surgical wards at our hospital and identified those who developed postoperative PE. We calculated Caprini score to assess the risk for VTE.

Results

Among patients admitted to surgical wards, we identified 107 cases of postoperative PE. Most of them had major surgeries, most of them were females, and a considerable proportion of those who developed PE did not receive thromboprophylaxis although being at moderate or high risk for VTE according to Caprini score. Few patients had poor outcome.

Conclusion

Perioperative thromboprophylaxis is crucial to avoid complication with VTE. Caprini score may be a good clinical score to decide which patients to receive perioperative thromboprophylaxis.
Lepra Reactions: Mimickers and Mirror to Unmask Complex Cases of Leprosy
Authors: Kumari Sandhya , Verma Ghanshyam K. , Negi Ajeet K. , Sharma Aakanksha
Published: April 2024

Leprosy is a silent disease with protean manifestations, especially during lepra reactions (LRs). Cases with atypical leprosy or LR simulate a number of conditions misdiagnosed frequently. Here, three classical cases of leprosy are reported for their complex presentation. Leprosy was hidden in Case 1 due to co-existing diabetes. COVID vaccination induced LR unmasked all leprosy lesions, which were extensive, large, bizarre and spreading to various immune zones. Case 2 presented with high-grade fever, tachycardia, generalized erythema and body aches. A detailed workup unveiled his leprosy with a rare presentation of Type 1 lepra reaction (T1LR) with erythroderma and severe systemic symptoms. Case 3 mimicked sarcoidosis and lupus erythematosus (LE) on routine workup. She had facial lesions in the malar area, photosensitivity, joint pains, raised angiotensin-converting enzyme (ACE) levels and positive anti-nuclear antibodies. Peri-appendageal granulomas on histopathology and therapeutic response to multidrug therapy helped in the early diagnosis of leprosy.
Comparison of the Clinical Efficacy of Rituximab Infusion and Dexamethasone-Cyclophosphamide Pulse Therapy and Their Effect on Serum Th1, Th2, and Th17 Cytokines in Pemphigus Vulgaris–A Prospective, Nonrandomized, Comparative Pilot Study
Authors: Khandpur Sujay , Sharma Preeti , Sharma Vinod K. , Das Dayasagar , Sharma Alpana , Bhari Neetu , Sreenivas Vishnubhatla
Published: April 2024

Background:

Rituximab infusion and dexamethasone-cyclophosphamide pulse (DCP) are the two most popular regimens used in pemphigus vulgaris (PV) in India.

Objective:

The present study compared the clinical efficacy of rituximab and DCP in Indian PV patients and their effects on serum Th1,2, and 17 cytokine levels.

Materials and Methods:

A total of 37 patients received DCP (Group A, n = 22) or rituximab (Group B, rheumatoid arthritis protocol (n = 15)) as per patients’ preference. They were monitored for clinical response, adverse events (AEs), changes in serum anti-desmoglein-1,3 antibody titers and Th1,2 and 17 cytokine levels at baseline and weeks 20 and 52.

Results:

The proportion of patients attaining disease control, remission, and relapse in groups A and B were 82% and 93%; 73% and 93%; and 27% and 50%, respectively, after a median duration of 2 months each for disease control; 4 and 4.5 months for remission; and 5 and 7 months for relapse post remission. The musculoskeletal AEs were the highest in the two groups. Significant and comparable decreases in anti-dsg1 and 3 titers from baseline to weeks 20 and 52 were observed in both groups. Th1 and Th17 cytokine levels decreased, while Th2 cytokines increased post-treatment in both groups. However, no correlation was found between change in body surface area of involvement by PV and anti-dsg titers and cytokine levels before and after therapy in both groups.

Conclusion:

Comparable clinical efficacy between DCP and rituximab was observed.
A Brief Review on Good Clinical Practice and its Training Methods
Authors: Mondal Himel , Mondal Shaikat
Published: April 2024

The field of clinical research continues to advance, and for ethical conduct of research, researchers need to have a strong foundation in good clinical practice (GCP). GCP guidelines are internationally recognized standards that govern the conduct of clinical trials, ensuring the protection of human subjects and the generation of reliable data. However, novice researchers or postgraduate medical students who would delve into research activities may face difficulty getting avenues for GCP training. Hence, in this brief review article, we discuss the significance of GCP in the field of clinical research with a glimpse of its history, development, and key principles. We provide a list of online courses, benefits, and disadvantages of those courses, and a list of organizations that conduct GCP workshops or continued medical education programs in India.
IJCM_103A: Cost Benefit Analysis Related to Community Acquired Pneumonia inpatients among Geriatric Age Group-A Study Conducted in A Tertiary Care Hospital
Authors: Behera Abhimanyu , Sethy Debasish , Pradhan Somen Kumar , Satapathy Durga Madhab
Published: April 2024

Background:

Community-acquired pneumonia (CAP) is a common acute infectious disease among elderly people, and is associated with high rates of hospital admission and mortality. Old Age and male sex are known risk factors for CAP among adults and many comorbidity are also risk factors for CAP, such as chronic obstructive pulmonary disease (COPD), diabetes, cancer, dementia, congestive heart failure, and liver function failure.

Objective:

This study aimed to estimate the economic burden of community- acquired pneumonia (CAP) among elderly patients in Berhampur, Odisha. In addition, the study evaluated the relationship between total treatment cost and CAP risk factors.

Methodology:

A cross-sectional study was conducted in the IPD of MKCG MKCG Medical College of Berhampur in the period of September-November 2023. Purposive sampling was used and data was collected using semi structured questionnaire and analyzed by MS Excel 2017

Results:

Among 348 are inpatient CAP episodes the mean ages were 63±8 years in outpatient group and 70±4 yrs in inpatient groups respectively. The Median treatment cost is Rs.3000/-INR per outpatient episode and Rs 10060/-INR per inpatient episode.Old patient, Male sex, Diabetes, Chronic obstructive Pulmonary Disease, liver dysfunction were associated with increased treatment cost.

Conclusion:

The economic burden of CAP might be decreased by reducing the number of hospitalizations for mild CAP and the incidence of severe CAP. Therefore, preventative care (e.g. oral hygiene or pneumococcus vaccination) is recommended for patients with related risk factors, such as male sex, older age, diabetes, chronic obstructive pulmonary disease.
IJCM_104A: Polypharmacy and medication adherence among elderly population in a rural area of Ernakulam district, Kerala.
Authors: Rasheed Amina , Aswathy S
Published: April 2024

Background:

Polypharmacy is the concurrent use of multiple medications. Although there is no standard definition, polypharmacy is often defined as the routine use of five or more medications. This includes over-the-counter, prescription and/or traditional and complementary medicines used by a patient

Objective:

The aim of the study was to assess the prevalence of polypharmacy, describe the number and types of drugs used, and to determine medication adherence in elderly population

Methodology:

A cross sectional study was conducted among 364 elderly population residing in Vypin Block of Ernakulam district, Kerala by probability-proportional-to-size sampling. A semi structured questionnaire was administered by face-to-face interview to collect details on sociodemographic profile, regular medications and Morisky Medication-Taking Adherence Scale- MMAS (4-item) to assess medication adherence. The study participants were categorized into poor and good adherence based on MMAS score

Results:

More than half (53%) of the elderly were females, with a mean age of 69 ± 7 years. The prevalence of polypharmacy among the study population was 14.6% [95% CI, 11-18.2]. The most commonly used medications (35%) were oral blood glucose-lowering agents, followed by antihypertensive drugs and lipid-modifying agents. The vast majority (86.5%) had good medication adherence according to MMAS score. The independent determinants of medication adherence in our study were males (aOR=2.53 CI 1.09-5.08; p= 0.03) Christian religion (aOR=3.84 CI 1.43-10.34; p=0.008), staying along with family (aOR=8.15 CI 2.04-32.5; p=0.003), having polypharmacy (aOR=3.69 CI 1.54-2.82; p=0.003) and not having to pay for medications (aOR=3.4 CI 1.51- 7.64; p=0.003) were found statistically significant with medication adherence

Conclusion:

In order to improve medication adherence, the health care system should focus on women, those who stay alone and those who have to pay for medications
IJCM_112A: Impact of competitive spirit on weight, waist circumference and HbA1c among the followers of Dixit Lifestyle participating in 90 Days weightloss and Diabetes Reversal Challenge
Authors: Dixit Jagannath
Published: April 2024

Background:

Author has initiated World free of obesity and diabetes campaign since 2013. This lifestyle suggests taking only two meals in a day and go for any cardio exercise for 45 minutes at a stretch every day. This lifestyle is showing great results in weight loss and diabetes prevention/remission. Through the campaign 90 days weight loss and diabetes reversal challenge was organized from 1t August to 31st October 2023.

Objectives:

1) To find out the effect of competitive spirit on weight and waist circumference among the participants 2) To find out the effect of competitive spirit on HbA1c and doses of diabetes medicines

Methodology:

Through messages on social media people were informed about the 90 days weight loss and diabetes reversal challenge. To join the challenge it was mandatory to submit there latest HbA1c and fasting insulin report, weight (Kg) and waist circumference (cm). Participants were categorized and added to non diabetic, prediabetic and diabetic WhatsApp groups having senior coordinators who monitored their progress. Members had to post screen shot of daily exercise and photo of daily meals. Weekly quizzes and various competitions were organized. Members filled daily google form and progress tracker at the end challenge with all parameters.

Results:

Out of 648 members 544 submitted all data at the end of three months which included 68 non diabetics, 253 prediabetics and 223 diabetics. Average weight loss was 4.12 Kg and waist circumference loss was 2.29 inches. Average HbA1c reduction was 0.428 gm%. 80 diabetics converted to prediabetic status and 10 to non diabetic status. 53 prediabetics became non diabetics. In 44 diabetics medicines were reduced and in 16 they were stopped.

Conclusion:

Competitive spirit while following Dixit Lifestyle has shown great results as regards weight loss, inch loss and HbA1c reduction.
IJCM_118A: Pathway of healthcare for breast cancer: A mixed method study among women with breast cancer attending a tertiary healthcare institute in Bihar
Authors: Ramalingam Anuvarshini , Naik Bijaya Nanda , Singh Pritanjali , Nirala Santosh Kumar
Published: April 2024

Background:

Breast cancer is the most common cancer among women; however, the majority of them visit hospitals at an advanced stage. Knowledge of pathway of care will aid in timely intervention and better prognosis.

Objectives:

To find the pathway of health care for breast cancer and its correlates among the patients who have attended AIIMS Patna. To identify the reasons for seeking delayed definitive care.

Methodology:

A mixed-method cross-sectional design with quantitative and qualitative parts was conducted at AIIMS Patna between March 2021 and December 2022 among breast cancer patients. A total of 171 breast cancer patients were enrolled in this study. Piloted study tools were used. Descriptive analysis for quantitative part and manual thematic analysis for qualitative part were performed.

Results:

Out of total 171 participants, 88.9% (83.3–92.77%) had visited AIIMS Patna indirectly. About 60 (20.6%) visited informal providers or quacks, and 60 (39.5%) of the study participants visited more than one hospital before arriving at AIIMS Patna. The place of residence, treatment delay, and stage of cancer were found to be independent predictors of the pathway of healthcare for breast cancer. The reasons behind seeking delayed definitive care were identified under two major themes: presentation delay (misunderstanding or difficulty in identifying symptom, neglect of disease, lack of awareness about the disease, family support, financial constraints) and treatment delay (misdiagnosis, multiple referrals, dissatisfaction with the treatment, COVID-19 lockdown, informal providers/quacks)

Conclusion:

9 out of 10 breast cancer patients had not come directly for definitive care, and among them, 3 out of 5 had visited multiple healthcare providers. So, it is important to educate the public on breast cancer, make systematized referral pathways, orient the private sector, and have trained manpower for screening purposes.
IJCM_120A: Factors associated with neonatal sepsis in tertiary care hospitals of Mangalore: A retrospective study
Authors: Verma Srishti , Mithra Prasanna , Unnikrishnan Bhaskaran , Rekha T , Kumar Nithin , Subhadarshini Divyasha , Dhal Sukanya , Jain Somesh , Mukhopadhyay Amrtapreeti
Published: April 2024

Background:

Neonatal sepsis remains a significant cause of morbidity and mortality globally, particularly in developing countries like India. Early and late onset sepsis present unique challenges in diagnosis and management, with maternal and neonatal factors playing crucial roles in the manifestation of the condition.

Methodology:

Data were collected from tertiary care hospitals affiliated with Kasturba Medical College, Mangaluru. A structured proforma was used to gather information on maternal factors, birth history, neonatal conditions, and complications. Statistical analysis was performed using Chi- square test and student’s ‘t’ test.

Results:

Out of 132 cases, 50.75% were early onset sepsis (EOS) and 49.25% were late onset sepsis (LOS). Blood culture reports were positive in 46.1% cases. Maternal comorbidities included gestational diabetes mellitus (GDM), antepartum hemorrhage (APH), and pregnancy-induced hypertension (PIH). Neonatal comorbidities such as convulsions, congenital malformations, neonatal jaundice, preterm birth, and low birth weight were observed. Positive blood culture reports correlated with low birth weight and preterm births. Staphylococcus aureus was the most common organism, followed by Citrobacter Spp., Enterobacter Spp., and Pseudomonas aeruginosa. Sensitivity analysis revealed varying degrees of susceptibility to different antibiotics.

Conclusion:

Maternal factors like GDM, APH, and PIH showed no significant correlation with neonatal sepsis, whereas neonatal factors such as low birth weight and preterm birth were associated with an increased risk. Consanguinity also emerged as a potential risk factor. Staphylococcus aureus was the predominant causative organism, with varying antibiotic sensitivities. This study underscores the importance of understanding maternal and neonatal factors in the prevention and management of neonatal sepsis.
IJCM_123A: Knowledge, Attitudes and Practice Regarding Travel Medicine among Health Care Students in Mangalore
Authors: Hassan Fizreena Izzyanti binti , Abdullah Sharifah binti , Lahiri Srutarshi , Johri Bhavini , Manoj Rohan , Kumar Nithin , Rekha T , Unnikrishnan Bhaskaran , Mithra Prasanna , Holla Ramesh
Published: April 2024

Background:

Travel medicine is crucial in addressing the health risks associated with international travel, especially among young adults who are increasingly mobile. Despite the growth in global travel, studies indicate a lack of awareness and adherence to preventive measures among travellers.

Objectives:

To assess the knowledge, attitudes, and practices of medical and dental students regarding travel medicine.

Methodology:

A cross-sectional study was conducted among medical and dental students at Kasturba Medical College and Manipal College of Dental Sciences, Mangalore, India. A convenient sampling method was employed, and data was collected using a pre-tested semi-structured questionnaire. The questionnaire assessed participants’ knowledge, attitudes, and practices related to travel medicine. Data analysis was performed using SPSS v20.0.

Results:

A total of 195 students participated, with a majority being female (72.3%) and in the age group ≤20 years (48.2%). Most participants had traveled internationally (71.3%) for purposes such as holidays (51.3%) and returning home (44.6%). While awareness of travel medicine was high (75.4%), knowledge levels were predominantly poor (50.3%). Participants showed high-risk perception towards health threats during travel but demonstrated low adherence to pre- and post-travel health check-ups. Key sources of information included the internet/social media (41.0%) and family/friends (35.9%).

Conclusion:

Despite high awareness, medical and dental students exhibited poor knowledge and inadequate adherence to preventive measures related to travel medicine. There was a notable disparity between perceived importance and actual practice of pre- and post-travel health check-ups. Efforts should be made to enhance education and awareness regarding travel medicine among young adults to mitigate travel-related health risks effectively.
IJCM_135A: Tobacco Burden, Legal Awareness, and Attitudes toward Control Measures among Healthcare Students, Professionals, and Staffs: Insights of an Online Survey in Bihar & Jharkhand, India
Authors: Biswas Bijit , Varshney Saurabh , Jahnavi G. , Narasimha Venkata Lakshmi , Nath Santanu , Venugopal Vinayagamoorthy , Ayub Arshad , Alam Benazir , Kumar Ujjwal , Jha Niwedita
Published: April 2024

Background:

Healthcare professionals, students, and workers are vital change agents in the global battle against tobacco. Yet, it’s important to note a concerning trend: there’s a high prevalence of tobacco use among them in India, although data on this is limited.

Objective:

This study aimed to assess tobacco use prevalence, awareness of related laws, and attitudes among healthcare professionals, students, and staff in Bihar and Jharkhand, India.

Methodology:

In July and August 2023, we conducted an extensive cross sectional, online survey across 24 tertiary healthcare institutions. Participants included a diverse group of medical, dental, and nursing students, faculty, resident physicians, nursing professionals, and support staff. The survey covered sociodemographic factors, tobacco use, awareness of laws (26 items) [a: 0.924), compliance practices (9 items) (a: 0.929), and perceptions of tobacco control (10 items) (a: 0.728).

Results:

Our research revealed a significant prevalence of tobacco use: 15.9% reported current use, with 9.6% as daily users. Notably, awareness levels differed noticeably between users and non-users, with non-users displaying deeper knowledge of tobacco-related laws in 61.5% of cases. Our multifactor logistic regression models for current (R2: 0.184, PAR: 84.1%) and daily tobacco use (R2: 0.203, PAR: 90.4%) highlighted various associated factors, including age, gender, marital status, occupation, family income, and native state. Importantly, insufficient awareness emerged as a key factor, correlating with higher chances of current and daily tobacco use. Regional differences were evident, with lower prevalence in southern states. A majority of faculty (90.0%) and students (93.6%) expressed the need for increased emphasis on tobacco control in healthcare curricula.

Conclusion:

Our research highlights disparities in healthcare tobacco use, influenced by age, gender, marital status, occupation, income, and location. Awareness plays a crucial role, emphasizing the need for integrating tobacco education into curricula and sustaining awareness campaigns to address this issue effectively