bluuebunny/crossref_metadata_2025 huggingface dataset:
A case series of multiple meningiomas with different histology
Authors: Shilpi Banga  , Hiba Salam  , Manpreet Singh Banga  , Sandeep BV  , Raj Swaroop Lavadi
Published: July 2023

Multiple meningiomas (MMs) tend to be benign with uniform histology. It is uncommon to find sporadic MMs having different histological features in the same patient. In this case series, of the four patients diagnosed with MM, two patients had different histopathology. An updated review of literature was then performed, providing the different histopathology in those cases. The first case was unique as the patient had an intradiploic meningioma with an intraparenchymal meningioma. Histology found in these cases represented WHO Grade I meningioma. After performing a literature search, it is likely that these tumors do not arise from clonal expansion, but rather have an independent origin.
Correlation of endometrial thickness using transvaginal sonography with histopathology in women with abnormal uterine bleeding: A cross-sectional study
Authors: Rajlaxmi Mundhra  , Kumari Prerna , Bahadur Anupama , Chawla Latika , Singh Rajni , Dibna Sinha  , Gupta Dipesh , Chaturvedi Jaya
Published: July 2023

Background: Abnormal uterine bleeding (AUB) is one of the most common complaints seen in gynecological practice, and transvaginal sonography (TVS) remains the first-line, non-invasive diagnostic tool in these women.
Aims and Objectives: The aim was to study the endometrial thickness (ET) using TVS and correlate it with histopathological findings obtained through endometrial biopsy in patients with AUB.
Materials and Methods: This was a prospective observational study conducted in a tertiary care center in Northern India, from January 2018 to June 2019. One hundred and sixty women in the reproductive age group presenting AUB were recruited. TVS was done to note (ET) and its echotexture with additional findings such as uterine, adnexal, or other pelvic pathology. The patient underwent endometrial aspiration using Karman Cannula, and its findings were correlated with TVS.
Results: In our study, a majority of patients (40%, n=64) presenting with AUB belonged to the age group of 41–45 years, with fibroid being the most common cause (39.3%, n=63). Thickened ET (>12 mm) was noted in 44 (27.5%) patients and 4 had an endometrial polyp. The mean ET was 11.48±5.11 mm (range: 4–35 mm). The most common normal histopathology noted was secretory endometrium (29.37%, n=47), followed by proliferative endometrium (20.6%, n=33). The abnormal changes included disordered proliferative endometrium (23.1% n=37) and simple endometrial hyperplasia (6.8%, n=11). Four cases were found to have endometrial adenocarcinoma. On correlating TVS with histopathology, it was noted that out of 8 patients with ET of >20 mm, 3 patients had endometrial carcinoma, 2 had disordered proliferative endometrium, and 1 each had pill endometrium, normal secretory, and atypical hyperplasia.
Conclusion: TVS provides crucial information on echo-morphological features of the uterine cavity, and increasing ET mandates histopathological confirmation for ruling malignancy.
Multistaged retrograde intrarenal surgery for large renal stones – our institutional experience
Authors: Periasamy Ponnusamy  , Rajasekar Sundaram  , Rajkumar Ramakrishnan  , Sammohit Gulakavarapu  , Shravankumar Savadatti
Published: July 2023

Background: Recent advances such as retrograde intrarenal surgery (RIRS) have become an acceptable and widespread technique for upper urinary tract stone management. However, the outcome and complication of staged RIRS for large stone burden (>2.0) still needs to be reported. A total of 150 cases of renal calculi were treated by RIRS in a single center. Among these, 30 had renal stone size larger than 2.0 cm.
Aims and Objectives: This study was conducted to present our views, experience, and outcomes of Retrograde Intra Renal Surgery for the Management of Large Renal Stones in Staged Manner using Flexible Ureteroscope with Holmium Laser as energy Source.
Materials and Methods: Between March 2020 and January 2022, we admitted 150 patients with upper urinary tract stones who underwent RIRS using 30 Watt Holmium laser lithotripsy in our institute. Post-surgery, all the cases are evaluated in terms of stone free rates (SFR) complications and effectiveness of RIRS.
Results: A total of 150 patients having upper urinary tract stones were included in this study (84 male and 66 female patients). All patients underwent RIRS using 30 watt holmium laser lithotripter. The overall SFR was 90.6%. The average stone size was 1.1 cm with average operation time of 100.6 min. Average hospital stay was 2.2 days. The average pain score was 2.1/10 by the Numerical Rating Scale. No major complications (Clavien Dindo III- V) were noted in the study groups.
Conclusion: Through our study, we concluded that RIRS for large renal stone management is an effective and safe treatment modality currently.
Changes in endotracheal tube cuff pressure with the changes in peak airway pressures during total laparoscopic hysterectomy and pelvic surgeries. A prospective and observational study
Authors: Sami Ullah Mujoo  , Sifna Tahir  , Umera Ikram
Published: July 2023

Background: The abdominal insufflation and changes in endotracheal tube (ETT) cuff pressure due to creation of pneumoperitoneum and changes in patient positioning during laparoscopic abdominal surgeries have not been explored thoroughly.
Aims and Objectives: The aim of our study was to see the changes in ETT cuff pressures during creation, maintenance, release of pneumoperitoneum, and during surgical positioning.
Materials and Methods: A total of 60 patients were finally taken for study. Written informed consent was taken for participation in the study as well as consent for surgery. Inclusion criteria were patients of age above 30 years, American society of anesthesiology physical status 1 and 2, patients undergoing total laparoscopic hysterectomy requiring trendelenburg positioning. Exclusion criteria were patients with pre-existing pulmonary or cardiac disease, patients with pre-existing vocal cord palsy, goitre or any other airway or thoracic pathology, pregnant or lactating females, BMI more than 25 or <18.5. Changes of cuff and airway pressures before and after abdominal insufflation in supine position and after head-down or head-up positioning were analyzed and compared.
Results: Baseline cuff pressure after manual inflation was 28.85±11.4 cm H2O. Significant correlation was observed between change in cuff pressure and increase in peak airway pressure at the end of the surgery (P<0.05). Serial measurements of ETT cuff pressure, peak airway pressure, and ETCO2 were significantly increased compared to baseline (P<0.05).
Conclusion: Pneumoperitoneum in Trendelenburg position increases ETT cuff pressure probably due to increase in airway pressure. Therefore, it seems advisable to include routine monitoring of ETT cuff pressure. Objective adjusted measurement of cuff pressure and airway pressures is recommended for such surgeries.
Status of thyroid hormones and its relation with eGFR in non-hemodialyzed advanced chronic kidney disease – A hospital-based cross-sectional study
Authors: Ranajit Bari  , Subhajit Paul  , Kuntolika Mani  , Partha Sarathi Karmakar
Published: July 2023

Background: Patients with chronic kidney disease (CKD) and significantly low estimated glomerular filtration rate (eGFR) or end-stage kidney disease have been linked to thyroid dysfunction. Renal function is also negatively impacted by thyroid disease.
Aims and Objectives: This study was conducted to find out magnitude of thyroid disorder in advanced CKD and to correlate eGFR with thyroid function status.
Materials and Methods: A hospital-based study was conducted among CKD patients to assess the thyroid disorders and its associated factors. A thorough clinical history was taken on chief complaints, any additional precipitating factors or co-morbidities (such as diabetes and hypertension), the use of any medications other than those for CKD in the past, any significant surgical procedures, and any episodes of hemodialysis. A morning blood sample was collected for thyroid function (T3, Free T3, T4, Free T4, and thyroid-stimulating hormone [TSH]) and kidney function test. According to KDIGO’s criteria 2017, CKD was identified.
Results: The current study included 60 individuals, with a majority of men (56.7%) and a mean (SD) age of 48.8 (8.4) completed years. 28.3% had low T3 syndrome. Hypothyroidism was seen by 15% and 28.3% had subclinical hypothyroidism. There was no identified hyperthyroidism patient. eGFR had positive correlation with free T3 (r=0.46, P=0.0002). It had a low positive (r=0.03, P=0.7) and weakly positive (r=0.14, P=0.2) correlation with total T3 and total T4. Free T4 and TSH both had negative correlations with eGFR (r=−0.17, P=0.1 and r=−0.09, P=0.4, respectively).
Conclusion: Patients with CKD had non-specific thyroid impairment, or decreased total T3 alone but no hyperthyroidism at presentation. The progression of CKD stage made it worse. There was significant positive correlation between free T3 and eGFR.
Endocrine dysfunction in transfusion dependent thalassemia patients from central India
Authors: Roshan Saras  , Anjali Bharani  , Gunvant Singh Eske  , Nilesh Jain
Published: July 2023

Background: Thalassemia refers to a group of genetically inherited diseases characterized by decreased or absent synthesis of normal globin chains resulting in defective globin chains. Most of the available studies in the literature have been done in adults and there is a paucity of studies highlighting the prevalence of hormonal dysfunction in transfusion dependent patients in pediatric age group. We conducted the present study with an aim to estimate the prevalence of hormonal dysfunction in transfusion dependent thalassemia (TDT) patients at a tertiary care center of Central India.
Aims and Objectives: The aim of the study was to estimate the prevalence of hormonal dysfunction in TDT patients at a tertiary care center of central India.
Materials and Methods: It is descriptive cross-sectional study conducted at tertiary care hospital MGM Medical College, Indore, Madhya Pradesh, conducted over a period of 12 months (August 2021–July 2022).
Results: Our study recruited a total of 100 children with age ranging from 9 year to 18 years with the mean age of 13.16±2.86 years. Sixty percent (n=60) of our study population were males and 40% (n=40) were females. The prevalence of hypogonadism was 35.18% analyzed in 54 patients, hypothyroidism was 10%, and diabetes was 5%. Although serum ferritin was very elevated in all patients with endocrine dysfunction; statistically significant association was found between serum ferritin and hypothyroidism (P=0.020).
Conclusion: Patients with TDT are often associated with endocrinopathies; most commonly hypogonadism, followed by hypothyroidism and diabetes. Early screening and treatment is necessary to improve their outcome.
Changes in central macular thickness before and after cataract surgery evaluated by optical coherence tomography in non-diabetic patient
Authors: Nilesh J Paraskar  , Vipul K Prajapati  , Jigna R Patel  , Sipra S Engineer  , Farhad Mansuri
Published: July 2023

Background: Optical coherence tomography (OCT) has been useful for objectively observing central macular thickness (CMT) changes inpre-operative and post-operative uneventful cataract surgery.
Aims and Objectives: This study was done to compare changes in CMT in small incision cataract surgery (SICS) and phacoemulsification surgery and to illuminate the OCT features of CMT after uneventful cataract surgery.
Materials and Methods: A prospective observational study was done at the tertiary eye care center from December 2019 to November 2020, a total of 60 patients underwent SICS and Phacoemulsification cataract surgery, were followed and examined postoperatively at day 1, 1 week, 1 month, and 6 months for whole ocular examination and OCT.
Results: Comparison analysis was performed using Friedman’s analysis of variance test.In SICS and Phacoemulsification group, statistical analysis differences between the mean CMT at pre-operative, post-operative 1 week, 1 month, and 6 months were found statistically significant (P > 0.001), subclinical macular edema (increase CMT without affecting visual acuity) was noted at 1 week and 1 month reviews.
Conclusion: The changes in CMT after cataract surgery are reversible, since the maximum measured increase in macular thickness at 1 month after surgery then gradually decreased at 6 months follow-up. This increase remained subclinical, and no evidence of clinical cystoid macular edema was seen on OCT.
An observational study comparing ormeloxifene with evening primrose oil for benign breast diseases
Authors: Anupam Banerjee  , Dipan Mukhopadhyay  , Tapati Mondal  , Swarup Chakraborty
Published: July 2023

Background: Fibroadenosis, popularly termed aberrations of normal development and involution (ANDI), is by far the most common female breast presentation to a surgeon. ANDI accounts for the most common breast lumps in women <30 years of age. Mastalgia, a significant spectrum of ANDI, is usually classified as (1) cyclical mastalgia (more common) and (2) non-cyclical mastalgia. Breast nodularity, the other spectrum of ANDI may either present as a predominant feature or coexist with mastalgia.
Aims and Objectives: The aims of this study were to comparatively study ormeloxifene and evening primrose oil with respect to regression of fibroadenosis and mastalgia and evaluate their side effects.
Materials and Methods: This prospective study was conducted in the Department of General Surgery of Calcutta National Medical College and Hospital, Kolkata from February 15th, 2021 to February 14th, 2022, after obtaining prior Institutional Ethical Committee Clearance. Two hundred and eighty patients were equally divided into two groups of 140 in each and screened for inclusion in this study.
Results: At the start of treatment, Group A (Ormeloxifene) presented with a mean visual analog scale (VAS) score value of 5.71, while patients of Group B presented with a similar mean VAS score value of 5. Group B recorded a VAS score of 4.50 at the end of the 6th month, while Group A recorded a significant downhill slope of negligible mean VAS score value of 0.80 at the of the 6th month. In breast nodularity gradings too, Group A showed significant down staging of grades returning, 95% confidence interval at the end of 6th month as 1.144, while 2.280 was recorded for Group B.
Conclusion: Benign breast disease is a common presenting problem in females of reproductive age. Ormeloxifene can be a better alternative to evening primrose oil in both cyclical and non-cyclical types of mastalgia. Larger trials are however required, to finally conclude on.
Early-onset metabolic syndrome and cardiovascular risk in polycystic ovary syndrome
Authors: Dhyaneshwar M  , Priyadarssini M  , Latha Chaturvedula  , Basu Sharbari
Published: July 2023

Background: Polycystic ovarian syndrome (PCOS) is a multifactorial endocrine disorder which along with insulin resistance leads to infertility and metabolic syndrome (MetS). This increases the cardiovascular risk in PCOS patients.
Aims and Objectives: The study was undertaken with the objective to assess and compare the levels of insulin, HOMA IR, lipoprotein (a), and comprehensive lipid tetrad index (CTLI) in PCOS patients with andwithout MetS and, thus, to compare the cardiovascular disease risk in the two groups.
Materials and Methods: Seventy-one freshly diagnosed cases of women with PCOS were enrolled in the study. The patients were grouped into PCOS with MetS and PCOS without MetS with 32 women in each group, matched by age. Biochemical parameters were analyzed in blood chemistry autoanalysers. Insulin, lipoprotein (a), was estimated using ELISA. HOMA IR and CTLI were calculated using standard formulae.
Results: About 48.6% of the patients with PCOS had MetS which developed at a mean age of 25 years. Blood glucose and lipid profile parameters were significantly higher, while high-density lipoprotein levels were lower in the group with MetS. Lipoprotein (a) and CTLI were also significantly higher in PCOS patients with MetS than in those without MetS. Insulin and HOMA IR, though higher in thePCOS with MetS group than in the PCOS without MetS, there was no significant statistical difference.
Conclusion: There is a higher risk of developing cardiovascular disease in PCOS women with MetS than in the PCOS women without MetS at a relatively younger age.
To compare the functional and radiological outcome between external fixation and volar plating for the treatment of intraarticular distal end radius fractures
Authors: Atul Kumar Saroj  , Ashutosh Verma  , Mohd. Baqar Abbas  , Upendra Kumar Patel  , Virendra Kumar
Published: July 2023

Background: Fracture of distal radius may be stable that is extra-articular, non-comminuted without distal radio ulnar joint disruption or unstable that is intra-articular, comminuted displaced with distal radio ulnar joint disruption. Complications of unstable fractures are shortening due to bone loss or due to resorption of the cancellous bone from metaphysis, resistant deformity, residual pain, late collapse, radio carpal arthritis and gross functional impairment.
Aims and Objective: The purpose of this study to compare the relative efficacy of external fixation versus plating with regard to functional and radiological outcome.
Materials and Methods: Total of 60 patients having intraarticular distal end radius fracture were included in this study and was equally divided into two groups, one group treated by external fixator other group with volar locking compression plate with or without augmentation by k-wire. Follow-up was done after 2 weeks, 4 weeks, 6 weeks and 3 ,6 and 12 months. The radiological evaluation was performed with Sarmiento’s Modification of Lindstrom’s Criteria. With the Modified Mayo Wrist Score, the patient’s functional outcomes were assessed and both groups were compared.
Results: In this study we found that volar plate group had good to excellent outcome in 73% cases and 07% with fair outcome however with external fixator group found good to excellent in 50% cases and poor in 17% cases.
Conclusion: In our study, we showed that the use of an external fixator and a volar locking plate for the treatment of intraarticular distal radial fractures were reliable. The relative simplicity of use, low surgical exposure, and decreased surgical trauma are benefits of external fixation. Despite these volar locking plates augmented with or without k wire had a good to excellent results in terms of early rehabilitation and less complications related to wrist joint. External fixator with ligamentotaxis provide significant good results in communited intraarticular distal end radius fracture.
Microbiological study of empyema thoracis among children in a tertiary care hospital
Authors: Sagarika Dhal  , Jyoti Ranjan Champatiray  , Dibya Prasana Mohanty  , Lalmohan Mishra  , Manoj Kumar Dehury  , Dharma Niranjan Mishra
Published: July 2023

Background: Empyema thoracis is a condition resulting in the accumulation of purulent fluid in the pleural cavity. It is a common source of illness among young children and is the most common sequela of bacterial pneumonia.
Aims and Objectives: This study was to determine the clinico-microbiological profile, causative agents, and antimicrobial susceptibility patterns of the isolates of the study population.
Materials and Methods: Prospective observational study was done in the Department of Microbiology, S. C. B. M. C. H., Cuttack. The study group comprised a total of 105 cases of empyema thoracis between the age group of 0–14 years, diagnosed by aspiration of pus from the pleural space. Complete histories of cases in detail were noted.
Results: A total of 41% of patients were in the age group of 5–9 years with M: F ratio of 1.1:1. Maximum cases 36 (34.3%) were seen in the spring season. Fever, cough, and breathlessness were the most common complaints. Bronchopneumonia 56 (53.3%), impetigo, and skin lesions 29 (27.6%) were the major predisposing factors. Right-side empyema 71 (67.6%) was more common than the left side 34 (32.4%). Culture revealed Staphylococcus aureus as the most common etiologic agent 26 (36.1%), of which 30.8% were methicillin-resistant S. aureus, followed by Mycobacterium tuberculosis complex 13 (18.1%). Finally, 103 (98.2%) empyema cases were recovered by antibiotics and tube thoracostomy.
Conclusion: Empyema thoracis is more prevalent in the lower socioeconomic population which can be prevented by an early diagnosis of pneumonia. Effective methods to treat empyema thoracis in children include the administration of proper antibiotics and tube thoracostomy in resource-poor settings.
The diagnostic and therapeutic evaluation of Idiopathic granulomatous mastitis. A case series
Authors: Barman Amalesh , Barman Ayanti , Khan Miraj Ali , Ranajit Bari
Published: July 2023

Idiopathic granulomatous mastitis (IGM) is a rare chronic inflammatory condition of the breast that is commonly found in young women of childbearing age with a history of recent breastfeeding. In our study, we aimed to present the detailed clinical and morphological features of IGM cases, diagnostic clues, and treatment. The most common clinical presentation is a unilateral, breast induration, nipple retraction, and even a multiple sinus formation often associated with an inflammation of the overlying skin. It usually mimics with breast abscess, rarely inflammatory breast cancer. Although etiology is still unknown. Many factors, including autoimmunity, infection, chemical agent, lactation, and hormonal imbalance, are supposed to play a role for etiology. Therefore, thorough history taking, examination, imaging, and histopathology make a proper diagnosis that determines the optimal management to be administered. We are presenting three cases of granulomatous mastitis from our clinical practice with varying clinical features. After the necessary investigation, we diagnose it as IGM. There is no definitive treatment guideline still now. In literature, many therapeutic operations, including conservative treatment, surgery, steroid, and immunotherapy, have been shown. However, we successfully treated this patient by conservative treatment, by incision and drainage, surgical debridement, or by in a combination of both, followed by regular dressing, antibiotics, and other supportive measures with no use of the steroid.
A rare case of left ventricular thrombus with ischemic MCA stroke in a lady with Crohn’s disease
Authors: Mandal Manamita , Vasudev S Parashar  , Praveen Kumar Yadav  , Misra Amar Kumar , Mukherjee Joydeep , Mohanty Bijendra , Kumar Sanjay
Published: July 2023

We report a case of Crohn’s disease (CD) presenting as a thromboembolic middle cerebral artery stroke due to a left ventricular (LV) thrombus in a 50-year-old lady. The proinflammatory and procoagulant state reported in CD seems responsible for this. The patient was managed with conservative treatment, but she died quickly. The findings highlight the rare occurrence of LV thrombus in a patient of CD as well as the need for aggressive control of disease activity with disease-modifying drugs at an earlier phase of treatment.
Assessment of echocardiographic variables in severe anemic patients
Authors: Goyal Sunita , Gupta Hariom , Ravi Prakash Pandey  , Tripathi VD
Published: July 2023

Background: Detection of left ventricular (LV) dysfunction in anemic patients using 2D strain echocardiography has been investigated inadequately.
Aims and Objectives: This study was designed to compare the echocardiographic characteristics in patients with severe anemia to those without anemia using a 2D strain pattern.
Materials and Methods: A cross-sectional study was conducted between April 2021 and March 2022. A total of 100 patients were incorporated in the case group, where patients with hemoglobin levels <7 g/dL, aged between 18 and 60 years, were included, whereas 100 patients with normal hemoglobin levels were included in the control group. Baseline clinical characteristics and echocardiographic parameters were studied.
Results: The mean age of the case group was 38.32±14.9 years and of the control group was 39.94±14.3 years. In each group, majority of the patients were females (55%) and were from rural area. Mean hemoglobin level was 4.81±1.42 g/dL in case group and 12.41±0.9 g/dL in control group (P=0.0024). Mean peak E velocity (P=0.0002), mean peak A velocity (P<0.0001) and mean isovolumetric relaxation time (P=0.4612) represented statistically significant differences among case and control groups. The ejection fraction was 58% in the case and 56% in control group (P=0.621). Stroke volume was 58 mL in the case and 52 mL in the control group (P=0.653). LV dysfunction represented a significant difference between case and control group (Chi=28.125; P=0.0001). Furthermore, a statistically significant difference was observed between the global longitudinal strain score of the case and the control group (P=0.0015).
Conclusion: Using 2D strain imaging technique, LV dysfunction was detected in severely anemic patients who had no previously detected severe cardiovascular diseases.
Microbiological profile of abscesses of different body sites in a tertiary care hospital – the silent killer
Authors: Sharmila Gupta  , Reena Ray Ghosh  , Maitreyi Bandyopadhyay
Published: July 2023

Background: Abscess, an infection with viable infecting organisms and polymorphonuclear cells, contained within a fibrous capsule, limiting the infection, and preventing its further spread. It may be monomicrobial or polymicrobial.
Aims and Objectives: The aims of the study were to determine microbiological profile of abscesses of different body sites and associated complications.
Materials and Methods: An observational study was conducted in our department with 35 pus samples from abscesses of different body sites between August 2022 and December 2022. Gram stain, Z-N stain, fungal stain, aerobic, anaerobic, and fungal culture were performed. Statistical analysis was done by statistical tool R.
Results: Out of 35 samples-limb, liver,paraspinal, psoas, appendicular, breast, perineal, ear, brain and lung abscesses were 11,4,2,3,1,7,2,2,2,1 respectively. Most common organisms from limb,ear,paraspinal and breast abscesses was MRSA (Methicillin resistant Staphylococcal aureus). Also most common organisms were – Escherichia coli from liver abscess, Enterobacteriaceae and Pseudomonas aeruginosa from psoas and appendicular abscess, Enterobacter aerogenes from perineal, Escherichia coli and Actinomyces species from brain and Candida auris from lung abcesses. No growth were also found in few samples. Their susceptibility testing showed-MRSA strains susceptible to both Vancomycin and Linezolid, gram negative bacteria were susceptible to Cephalosporins, Piperacillin-tazobactam, Carbapenems, polymixins, etc. C.auris was resistant to all antifungals. Their blood samples were also collected - ten patients showed fever with bacteremia and one with candidemia . They were treated with systemic antimicrobials along with drainage and/or surgical resection.
Conclusion: Abscesses must be suspected in cases with non-resolving fever with/without septicemia and treated promptly with appropriate antimicrobials based on susceptibility report and with drainage and/or surgical resection.
Effectiveness of heartfulness meditation on cognitive and autonomic functions in women with premenstrual syndrome
Authors: Umadevi B  , Nalina N  , Sujaya B  , Sai Sailesh Kumar Goothy
Published: July 2023

Background: Heartfulness meditation is heart-based meditation that helps to balance the mental status. The relaxation offered by meditation is so valuable as it not only improves quality but also improves the quantity of life. However, there is a requirement for the long-term practice of these meditations to receive their effects. The relaxation offered by meditation is very promising that it causes improvement in cognitive functions and sleep patterns.
Aims and Objectives: The present study was undertaken to observe the effectiveness of heartfulness meditation on cognitive and autonomic functions in women with premenstrual syndrome (PMS).
Materials and Methods: The present study was an experimental study. A total of forty females with PMS were part of the study. After recording the baseline values in the pre-menstrual period, the participants were trained in heartfulness meditation for weekdays by an expert. Later, they were asked to practice the heartfulness meditation daily for half an hour for 8 weeks at the meditation center of the college. After 8 weeks of practice of the heartfulness meditation, post-intervention values were recorded. Cognitive parameters were assessed using the spatial and verbal memory tests. Blood pressure and pulse rate were assessed using a diamond digital sphygmomanometer.
Results: There was a significant improvement in spatial memory, and verbal memory scores followed by meditation. There was a significant decrease in systolic and diastolic blood pressure and pulse rate followed by the intervention.
Conclusion: The study results in support earlier studies as there was a significant improvement in the cognitive scores and a decrease in the autonomic parameters in the participants followed by the practice of the heartfulness meditation. Further detailed studies are recommended to support the incorporation of heartfulness meditation into the routine day lifestyle.
Assessment of the clinicodemographic parameters and treatment outcomes of locally advanced and metastatic lung cancer cases – A retrospective study from northeast India
Authors: Satya Sadhan Sarangi  , Munlima Hazarika  , Partha S Roy  , Nithin D Raj  , Partha P Medhi  , Anupam Sarma
Published: July 2023

Background: There are many lacunae in our current understanding of the shifting epidemiological trends of lung cancer as well as lack of data among Northeast Indian patients.
Aims and Objectives: This study tried to assess the clinicodemographic and treatment outcomes of advanced lung cancer cases.
Materials and Methods: This was a retrospective hospital-based study. Patients with histopathologically confirmed locally advanced and metastatic lung cancer and were registered at Dr. Bhubaneswar Borooah Cancer Institute between January and December 2017 who were included in the study. A record was made of patient demographic-, clinical-, and treatment-related parameters. Kaplan–Meier survival curves were obtained. A two-tailed P<0.05 was considered statistically significant.
Results: Majority of the patients were elderly males (median=60 years), with a history of smoking in three quarter of them. Non-small-cell lung carcinoma (94%) type was the most common histology. About 93% of patients presented with TNM stage IV disease. The most common palliative chemotherapy (CT) regimen used was taxanes and platinum doublet (n=24, 35%). With a median follow-up of 6 months (range 0–37), the median progression-free survival and overall survival were 8 months and 10 months, respectively. The median survival was significantly longer in patients younger than 60 years. (13 months; P=0.021) and in those with non-small-cell histology (10 months).
Conclusion: In this audit of resource-limited population with advanced lung cancer, palliative CT remains the mainstay of treatment. There is a further need to improve the survival of these advanced cases in a cost-effective manner.
A comparative evaluation of intraperitoneal instillation and periportal infiltration of 0.375% ropivacaine with dexmedetomidine and nalbuphine as adjuvants for post-operative analgesia in laparoscopic cholecystectomy
Authors: Shagufta Bhat  , Tufail Ahmad Sheikh  , Rajesh Angral  , Heena Saini  , Anshuman Mahesh Chander
Published: July 2023

Background: Intraperitoneal instillation (IPI) of local anesthetic agents into peritoneal cavity has proved to be an effective method of post-operative analgesia in laparoscopic cholecystectomy (LC). The addition of adjuvants such as narcotics or α2-agonists has been proposed to prolong the duration of post-operative analgesia.
Aims and Objectives: This study aimed to compare post-operative analgesia of IPI and periportal infiltration of ropivacaine plus dexmedetomidine with ropivacaine plus nalbuphine in patients undergoing LC.
Materials and Methods: This was a comparative, prospective, randomized controlled double-blind study conducted on total of 100 patients (American Society of Anesthesiologists class I and II) planned for LC who were randomly divided into two groups of 50 patients: Group Ropivacaine+Dexmedetomidine (RD) received IPI and periportal infiltration of 150 mg of ropivacaine (0.375%) and dexmedetomidine (1 μg/kg) diluted with normal saline to 40 mL and Group Ropivacaine+Nalbuphine (RN) received 150 mg of ropivacaine (0.375%) and 10 mg nalbuphine diluted with normal saline to 40 mL. Post-operative pain was assessed by Visual Analogue Score, time to first request of analgesia, and total amount of rescue analgesics given in 24 h and side effects were noted. Data were analyzed by Student’s independent t-test and Chi-square test using SPSS version 20.0.
Results: Overall Visual Analog Scale scores (1.38±0.78 vs. 2.59±1.15), time to first request of analgesia (7.3±3.74 vs. 4.2±2.71), and total analgesic consumption (82.4±15.34 vs. 158.5±16.19) were significantly lower in the RD group compared to the RN group. Among post-operative adverse events, the incidence of post-operative nausea and vomiting was significantly higher in the RN group.
Conclusion: The addition of dexmedetomidine appears to be superior to nalbuphine in terms of prolonged post-operative analgesia, lesser requirement of rescue analgesia, and less complications.
Effect of position - Trendelenburg and horizontal on the height of sensory block in patients undergoing lower abdominal surgery
Authors: Sarmila Guha Banerjee  , Shantanu Hazra  , Akashleena Banerjee  , Ujjwal Bandyopadhyay
Published: July 2023

Background: Subarachnoid anesthesia also known as spinal anesthesia is now considered to be a safe form of anesthesia for lower abdominal and lower limb surgeries. The height of sensory block achieved in spinal anesthesia after drug administration can be altered by changing the position of the patient, and this precisely is the advantage of using hyperbaric local anesthetic drug.
Aims and Objectives: The aim of this study is to compare the effect of position – horizontal and Trendelenburg on the height of sensory block in spinal anesthesia.
Materials and Methods: After obtaining the institutional ethical clearance, total 66 patients scheduled for lower abdominal surgery under spinal anesthesia were selected and divided into two groups – Group A patients were placed in Trendelenburg position with 20° head down for 40 s and then returned to horizontal position and Group B patients were placed in horizontal position after spinal anesthesia. The level of sensory block was compared among the two groups at different points of time up to 30 min of drug administration.
Results: The patients who remained in Trendelenburg position for 40 s after spinal anesthesia achieved a higher level of sensory block earlier as compared to the horizontal group and the maximum block height was two spinal segments higher than that of the horizontal group.
Conclusion: From our current study, we can conclude that Trendelenburg position can be used to achieve a higher level of sensory block as compared to horizontal position after successful neuraxial block.
Use of optical coherence tomography retinal thickness deviation map for hydroxychloroquine retinopathy screening
Authors: Jitendra Kumar  , Surabhi Gupta  , Rashmi Kumari
Published: July 2023

Background: Hydroxychloroquine (HCQS) is widely used to treat several rheumatic and skin diseases and can cause damage to the outer retina, known as HCQS retinopathy, and is common among long-term users of the drug with higher daily dose by weight. The goal of screening for retinopathy is to recognize signs of toxicity at an early enough stage to prevent the loss of visual acuity.
Aims and Objectives: This study aimed to evaluate the diagnostic performance of a commercially available retinal thickness deviation map obtained by spectral-domain (SD) optical coherence tomography (OCT) for screening of HCQS retinopathy.
Materials and Methods: This study was a prospective comparative study between unaffected (patients who did not develop retina toxicity) and affected (who developed toxicity) of 50 patients of the age group of 14–60 years taking HCQS medication for several dermatological and rheumatologic disorders. The patients who fulfilled the inclusion criteria were screened for HCQS retinal toxicity using SD-OCT, standard automated perimetry, fundus autofluorescence, and comprehensive ophthalmic examinations.
Results: In this study, in group 2 patients, 60% were having parafoveal, 30% having perifoveal, and 10% having a mixed pattern (P<0.001) of HCQS retinopathy, and the mean deviation and pattern standard deviation increase as the severity of disease increases (P<0.005).
Conclusion: This study concluded that HCQS is a safer drug and can be used safely in these patients with proper HCQS retinal toxicity monitoring with an SD-OCT-generated retinal thickness deviation map and with regular follow-up to monitor reduced thickness in the parafoveal region.
Change in the quality of life in the patients of laryngeal and pharyngeal carcinoma after receiving radiation therapy: A prospective and observational study
Authors: Siddhartha Adhikary  , Rajat Bandyopadhyay  , Suparna Banerjee  , Amit Sarkar
Published: July 2023

Background: The quality of life (QoL) of laryngeal and pharyngeal carcinoma patients is influenced by the side effects of treatment affecting functions such as swallowing, feeding, and speech, more so following conventional radiation using 2D technique.
Aims and Objectives: This study was undertaken to determine the change in QoL of laryngeal and pharyngeal cancer patients after radiation using 2D technique in a Telecobalt unit in a resource constrained peripheral institution.
Materials and Methods: In this prospective, observational, and single institutional study, fifty-one larynx and pharynx cancer patients were treated with radiation/chemoradiation in telecobalt unit using conventional 2D technique. QoL was evaluated using European Organisation for Research and Treatment of Cancer Quality of Life (EORTC QLQ) C30 and EORTC QLQ Head and Neck Module (HN43) pre-validated and locally adapted questionnaires at pre-treatment, immediately, 3 months and 6 months after radiation. The difference between the scores at different time points was verified using Friedman’s non-parametric test.
Results: Of the 46 evaluable patients, 71% were male with median age of 56.5 years, median follow-up of 8 months; 15 patients (32%) had Stage II disease and 78% of patients received concurrent chemotherapy. There was statistically significant deterioration of global health status and functional scales immediately after radiation. All the symptom scales of QLQ C30 and QLQ HN43 except neck swelling showed significant worsening at the end of radiation. After 6 months, the Global health status and all functional scales showed statistically significant improvement. Most symptom scales of QLQ C30 (except appetite loss and fatigue) were statistically significantly improved. At the end of 6 months, most of the symptoms showed significant improvement reaching pre-treatment values. There were however worsening of symptoms such as dry mouth, sticky saliva, and mouth opening.
Conclusion: Laryngeal and pharyngeal carcinoma patients suffered from a deterioration of QoL after radiation. Six months later, most of the QoL scales showed a statistically significant improvement. These negative impacts on QoL can be reduced by use of newer techniques of radiation therapy such as 3D conformal radiotherapy, intensity-modulated radiation therapy, and image-guided radiation therapy.
Life events in obsessive-compulsive disorder: A cross-sectional study
Authors: Subir Bhattacharjee  , Prabir Kumar Kundu  , Shatabdi Saha
Published: July 2023

Background: Obsessive compulsive disorder (OCD) is a chronic psychiatric disorder having significant deterioration in patients’ socio-occupational functioning. Stressful life events (SLE) were noted before onset of this disorder. The previous study with Indian population found positive correlation between stressful and traumatic life events and OCD, but was with small sample size and thus result couldn’t be generalized.
Aims and Objectives: The aim of the study was to examine the role of life events in patients with OCD and to find out correlation between them, if any.
Materials and Methods: Consecutive 30 OPD patients fulfilling ICD-10 DCR criteria for OCD were rated with Yale Brown Obsessive Compulsive Scale (YBOCS), Hamilton Rating Scale for Depression (HAM-D), Hamilton Rating Scale for Anxiety (HAM-A), and Presumptive Stressful Life Events Scale (PSLES). A group of 30 healthy controls from unrelated patient party were also rated on PSLES. Finally, both groups were statistically compared in terms of life events.
Results: Two groups were identical in distribution of age and sex. The frequency of life events, 1-year (P=0.000) and lifetime (P=0.000), were significantly higher in OCD group in comparison to healthy controls. There was significant positive correlation between PSLES scores and YBOCS scores. Step-wise linear regression analysis found positively predictability of PSLES score to OCD severity.
Conclusion: OCD patients have statistically significant SLE before the onset of their disorder and total number of life events has positive correlation with severity of OCD.
A comparative study between covering ileal loop-without ostomy or delayed ostomy and diversion ileostomy for patients undergoing large bowel anastomosis
Authors: Sathyaraj P  , Jemin Bharath R  , Renganathan M  , Kalaiselvan N  , Mukesh Kumar P
Published: July 2023

Background: In elective and emergency general surgery, bowel anastomoses are common procedures. Although several stoma-related issues may arise following stoma creation, establishing a stoma is incredibly morbid.
Aims and Objectives: The study compares patients with diversion ileostomies (stomas) to those who had to cover ileal loops without ostomies or delayed ostomies for large bowel anastomosis to compare the risks and advantages of each procedure.
Materials and Methods: This prospective and comparative study was conducted on 50 patients undergoing large bowel anastomosis. Patients were divided into two groups: Group A: Those with covering ileal loop without or delayed ostomy, and Group B: Those undergoing diversion ileostomy.
Results: Demographic data of the study indicated that most of the participants in both groups were male (72% in covering ileal loop and 64% in diversion ostomy). In both groups, most participants belonged to the >45 age group. We have seen a significant difference in the setting of surgery, Vitamin B 12 levels, early complications, late complications, and time of takedown comparing covering ileal loop to the diversion ostomy group.
Conclusion: This study showed reduced postoperative morbidity and complications of stomas following covering ileal loop compared to diversion ileostomy. Hence, the technique should be considered.
Scatter gram patterns of hematological malignancies in Sysmex XN series
Authors: Kovuri Umadevi  , Lavanya Motrapu  , Mohd Imran Ali  , Rajarikam Nagarjunachary  , Seshava Puri Smitha Vadana
Published: July 2023

Background: Scatter grams-graphic depictions of the cell populations in a blood sample are produced by automated analyzers. These scatter grams can be employed to screen for various hematological conditions, including anemia, leukemia, and other blood disorders by examining the scatter gram’s cell population distribution and patterning.
Aims and Objectives: In this study, we wish to study the scatter grams generated by the Sysmex XN-series analyzer for confirmed cases of hematological malignancies.
Materials and Methods: In this study, 58 cases of hematologic malignancies diagnosed based on peripheral smear findings and bone marrow morphology data were extracted. We retrieved the complete blood count and scatter gram patterns analyzed by Sysmex XN-1000 analyzer for these cases along with peripheral smear findings. Scatter gram patterns in white blood cell differential and white cell nucleated were analyzed correlating with peripheral smears.
Results: Among 58 cases, 20 cases were acute myeloid leukemia (6 were acute promyelocytic leukemia), 32 cases were chronic myeloid leukemia, and 5 cases were chronic lymphocytic leukemia. Unique scatter gram patterns were seen with different leukemias.
Conclusion: Pattern analysis of scatter grams has the potential to improve the efficiency and accuracy of leukemia diagnosis and also help to prioritize the evaluation of cases that require further testing, such as molecular and cytogenetic evaluations, especially in limited resources or high sample volumes conditions.
Transverse versus vertical incision approach in elective ventral hernia repair - A comparative study
Authors: Renganathan M  , Mukesh Kumar P  , Sathyaraj P  , Amanyu T  , Jemin Bharath R
Published: July 2023

Background: Ventral hernias are commonly associated with not infrequent complications and significant recurrence rates, often resulting in future procedures. The relative merits and disadvantages of vertical versus transverse incisions remain subjects of active debate.
Aims and Objectives: The study aims to compare the relative merits, demerits, and outcomes between patients of ventral hernia who have undergone open mesh repair through a transverse incision and a vertical incision.
Materials and Methods: In this prospective study, 100 patients were admitted to Government Rajaji Hospital for ventral hernia repair and those satisfying the inclusion criteria were divided into two groups, A and B, 50 each. In group A, open mesh repair was done through a transverse incision; in group B, open mesh repair was done via a vertical incision. The study compared the incidence of surgical site infection (SSI), flap necrosis, wound dehiscence, pain, and mean hospital stay.
Results: On comparing the groups, it has been seen that the incidence of significant pain (taken as a visual analog scale score of 3.5 or more) was 16% in group A (transverse incision) compared to 34% in group B (vertical incision), which is statistically significant. The incidence of SSI, flap necrosis, wound dehiscence, and mean hospital stay were more or less the same and statistically insignificant.
Conclusion: The group in which a transverse incision was used for ventral hernia repair showed significantly less post-operative pain than the group in which a vertical incision was used. Hence, the use of transverse incision in elective open mesh repair for ventral hernias should be considered.
Facial nerve palsy: An atypical presentation of dengue fever
Authors: Mukherjee Rishav , Debarup Das
Published: July 2023

Dengue fever is a grave public health concern in tropical countries. The disease spectrum of dengue fever is multi-systemic, although neurologic complications of dengue fever is relatively uncommon. The pathogenesis of neurologic manifestations in dengue fever is not well understood and may be due to the neurotrophic effect of the virus, or related to the systemic effects of dengue infection, and immune mediated. Here in, we discuss the occurrence of isolated 7th cranial nerve lower motor neuron type palsy in a 23-year-old lady suffering from dengue fever. To date, there are very few case reports citing the involvement of facial nerve in dengue fever.