bluuebunny/crossref_metadata_2025 huggingface dataset:
Study of the incidence and profile of acute transfusion reactions in children
Authors: Sithara Subair  , Preeti Malpani  , Urvashi Channa
Published: January 2025

Background: Blood is a vital human tissue and a precious health resource. Use of these components may be associated with adverse events, which compromise the efficiency and safety of blood transfusion. The incidence of adverse transfusion reactions has declined with modern facilities like improved screening and transfusion practices, but some are still observed due to alloimmunization, bacterial contamination, immunomodulation, etc.
Aims and Objectives: To study the incidence and profile of acute blood transfusion reactions (ATR) in pediatric patients at our center.
Materials and Methods: We monitored ATRs in patients receiving blood components among the age group of 1 month–18 years, during September 2021–August 2022. A detailed proforma was used to collect data from patients developing ATR.
Results: ATRs were observed among 329 patients (3.9%) out of 9501 transfusions. In decreasing order of frequency, febrile nonhemolytic transfusion reactions (3.3%), allergies (0.5%), hemolytic reactions (0.1%) were observed. ATRs were most commonly observed with red cell concentrate transfusions (90.6%) followed by platelets (7%) and then plasma (2.2%) (P=0.059). Most of the reactions occurred within 1st 2 h (82.4%) of transfusion and the most common symptom recorded was fever (61.5%) followed by chills and rigors (20.9%). We found a significant association between ATRs and previous history of blood transfusion (81.8%) (P<0.00001) and also with storage of blood components for more than 3 days (88.8%) (P=0.019).
Conclusion: The prevalence of ATR was 3.9% among pediatric patients in our setup. Knowledge of risk factors associated with transfusion reaction will help in improving transfusion practices.
A comparative study of the efficacy and safety of thiocolchicoside and chlorzoxazone in patients with acute musculoskeletal pain
Authors: Rajeev Kumar Togiti  , Raj Kumar Goud K  , Kiran D  , Ramakrishna K  , Suresh Babu Sayana
Published: January 2025

Background: Thiocolchicoside and chlorzoxazone are commonly used muscle relaxants for the management of acute musculoskeletal pain. However, there is limited evidence comparing their efficacy and safety.
Aims and Objectives: The aim of the study was to compare the efficacy and safety of thiocolchicoside and chlorzoxazone in patients with acute musculoskeletal pain.
Materials and Methods: This was a randomized, open-label, parallel-group study conducted in a tertiary care hospital. A total of 50 patients with acute musculoskeletal pain were randomized to receive either thiocolchicoside (8 mg) or chlorzoxazone (500 mg) thrice daily for 7 days. The primary outcome measure was the change in pain intensity from baseline to Day 7, assessed using a visual analog scale (VAS). The secondary outcome measures were the percentage reduction in pain intensity and the incidence of adverse events.
Results: The baseline characteristics of the patients were similar in both groups. The mean baseline pain intensity was 7.2±1.3 in the thiocolchicoside group and 7.1±1.2 in the chlorzoxazone group. After 7 days of treatment, both drugs significantly reduced pain intensity from baseline. The mean pain intensity at Day 7 was 2.9±1.1 in the thiocolchicoside group and 3.1±1.2 in the chlorzoxazone group. The percentage reduction in pain intensity was 59.7%±12.3% in the thiocolchicoside group and 56.3%±11.5% in the chlorzoxazone group. However, there was no statistically significant difference between the groups in terms of pain intensity reduction (P=0.453).
Conclusion: The results of this study suggest that thiocolchicoside and chlorzoxazone are equally effective and safe in the management of acute musculoskeletal pain. The choice of drug may depend on the patient’s individual characteristics and risk factors.
Impact of lag time on lung function impairment in pulmonary tuberculosis sequelae patients – A cross-sectional study
Authors: Sreekaanth S  , Ragulan Rajalingam  , Jereen Varghese  , Viswambhar V  , Vidhya Priya
Published: January 2025

Background: Treatment completed pulmonary tuberculosis (PTB) patients are often left with permanent pulmonary function impairment. Lag time remains a major factor in determining the severity of the sequelae.
Aims and Objectives: This study aims to assess the impact of lag time on PTB sequelae.
Materials and Methods: A cross-sectional study was conducted during July 2019–December 2020. A total of 85 patients presenting with clinicoradiological features of PTB sequelae were recruited for the study and spirometry and diffusion capacity of lungs (DLCO) were done. They were divided into study groups based on lag time. The lag time (in days) was considered as primary explanatory variable. One-way ANOVA and Chi-square tests were used. coGuide V.1.0 was used for statistical analysis.
Results: The mean lag time was 52.94 days in the study population. The mean duration of after treatment was 15.45 years in the study population. There was a statistically significant difference across study groups (classified based on the lag time) in lung function such as FVC%, FEV1, FEVI/FVC, MEF, DLCO, and duration of after treatment (P<0.05).
Conclusion: The lag time from the development of symptom to the diagnosis of the disease has a significant impact on lung function impairment in PTB sequelae patients since the increase in lag time increases the severity of lung function impairment. Early identification and treatment may help in reducing the progression of lung function impairment.
A study of comparison between quality of life early closure of ileostomy and late closure of ileostomy
Authors: Neeraj Kumar Banoria  , Pankaj Saunakiya  , Muktesh Kumar Maurya
Published: January 2025

Background: In the developed countries, ileostomy is mainly constructed as a protective cover for distal colorectal or ileoanal pouch anastomosis, but in developing countries, it is still often made in emergency surgical settings where infective conditions such as enteric or tubercular perforations are common and patients present late in their course of illness which precludes primary closure.
Aims and Objectives: The aim of the present study is to compare health-related quality of life at 3, 6, and 12 months comparing early versus late closure of a temporary ileostomy.
Materials and Methods: The study was conducted on 50 patients, 25 patients undergoing for early stoma closure and 25 patients undergoing for late closure ileostomy each in Maharani Laxmi Bai Medical College, Jhansi, between January 2020 and June 2021.
Results: The mean age of patient undergoing early closure is 36.16 and mean age of patient undergoing late closure is 40.36, out of which 80% were male patient and 20% patient were female. Using SF-36 questionnaire, out of 8 domains, quality of life of early closure of ileostomy is significantly better in respect of 3 domains and that is physical functioning – P=0.004. Mean±SD score for early stoma closure 80.6±22.495 for late closure 73.00±25.247. Social functioning P=0.05. Mean±SD score for early stoma closure, 74.00±4.243 late stoma closure 71.50 ±0.707. Role emotion P=0.04, Mean±SD score for early stoma closure 80.00±4.00 late closure 74.67±12.20.
Conclusion: We concluded that quality of life in early closure of ileostomy is significantly better in respect of 3 domains (physical functioning, social functioning, and role emotion) out of 8 domains in SF-36 questionnaire than quality of life in late closure of ileostomy.
CASS – A cost-effective strategy in the management of blunt trauma abdomen
Authors: Raghuveer MN  , Dinesh HN  , Bagdalkar Ankitha
Published: January 2025

Background: Abdominal trauma is one of the leading causes of morbidity and mortality in both developing and developed countries. Management of blunt trauma abdomen (BTA) relies on most importantly, the clinical presentation of the patient.
Aims and Objectives: This study aims at determining the accuracy of the clinical abdominal scoring system (CASS) in predicting the need for operative management of blunt abdominal trauma patients and also comparing the CASS score with the American association for the surgery of trauma – computed tomography (AAST CT) score.
Materials and Methods: A total of 50 patients with BTA presenting to the Government tertiary care center Mysore were evaluated for age, sex, type of trauma, systolic blood pressure, Glasgow coma scale, pulse rate, time of presentation after trauma, abdominal clinical findings, respiratory rate, and hemoglobin concentration. Radiological investigations were done as indicated. CASS score was calculated and a comparison of the same with CT findings, in determining the need for laparotomy, was studied. Patients with co-existing head injuries and comorbidities were excluded from the study.
Results: Among 50 cases, 44 were male accounting for 88% of the study population and 6 were female. The majority belonged to 18–30 years of age, accounting for 46%. In 42% of cases, a road trafficaccident was the mode of injury, followed by a fall from height in 4%. Latent period 52% of cases presented to the hospital between 0 and 6 h of the incident. 10% associated chest injuries. 42% showed splenic injury, thereby making it the most commonly injured organ. 28% had the liver injury. 28% had hemoperitoneum with source of bleed being unknown.
Conclusion: CASS is a reliable and promising scoring system with sensitivity comparable to AAST CT grading in determining the need for surgical intervention in BTA patients. CASS provides an effective means of saving time and resources and gives the added advantage of avoiding expenses to underprivileged patients in our country.
Atypical early presentation of subacute sclerosing panencephalitis in children: A case series
Authors: Sukanya Nath  , Kanai Lal Barik  , Abu Obayed  , Sumanta Laha  , Sayan Bera
Published: January 2025

Subacute sclerosing panencephalitis (SSPE) is a progressive neurodegenerative disease of children and young adults that may occur as an uncommon complication 7–10 years after a measles infection. In measles – endemic countries like India, the incidence of this fatal disease is high and more number of new cases are detected in recent times. In this case series, we have presented three cases of SSPE between the 4 and 5 years age group, presented with abnormal movement and neuroregression and diagnosed by characteristic clinical features, raised anti-measles antibody titer in CSF, and typical Electroencephalography findings. All of them had a history of measles infection before the vaccination and very short latency period between measles infection and the development of SSPE. They were discharged in stable condition after the treatment with oral Isoprinosine and intrathecal Interferon alfa 2b. Early age of presentation, short latency period, and apparently good response to treatment for the time being prompted us to present these cases.
Needle preceding the scalpel in soft-tissue sarcomas – A case series
Authors: Vikram R  , Rashmi MV  , Nischita Budihal  , Kanaka R
Published: January 2025

Soft-tissue sarcomas (STSs) are rare neoplasms that can be initially evaluated by fine-needle aspiration cytology (FNAC). Although they are difficult to subtype, these sarcomas can be graded and classified based on cytomorphology. FNAC, with clinical and radiological correlation, can be effectively used in the diagnosis of STSs. Application of ancillary techniques is essential to arrive at the final diagnosis. The aim of the study was to determine the efficacy of FNAC in the initial diagnosis of STSs. Three patients who presented with soft-tissue masses were initially evaluated by ultrasound and/or magnetic resonance imaging and FNAC. Following which, all the three cases were operated on and studied on histopathology and immunohistochemistry to arrive at a final diagnosis. All the three cases were diagnosed as malignant on FNAC even when radiology findings differed or was not confirmatory in one case. FNAC diagnosis was appropriate in case of grading of tumors and classification based on morphology in all the three cases. FNAC of soft-tissue tumors (STTs) is a quick, reliable, and cost-effective mode of initial investigation for STTs. Although it is difficult to subtype the diagnosis, in majority of the cases, a diagnosis of benign or malignant and grade of the tumor can be assessed.
Incidental pathologies in appendectomy specimens - An interesting series of cases in a tertiary care center in Eastern India
Authors: Sanghamitra Mukherjee  , Debajyoti Singha Roy  , Vandana Maroo  , Meghadipa Mandal
Published: January 2025

Acute appendicitis is the most common surgical emergency worldwide, with appendix being the most frequently encountered specimen by a reporting histopathologist. They may sometimes show rare and uncommon histomorphologic pictures that may create diagnostic dilemmas, few of such cases being discussed here. There are two cases of appendicular neuroendocrine tumors (NETs) that initially presented as acute appendicitis clinically, with microscopic tumor foci measuring <1 cm each. Immunohistochemistry for synaptophysin substantiated the histopathological diagnosis in one case. Neurogenic appendicopathy is another non-neoplastic entity discussed that may be overdiagnosed as appendicular neoplasms such as NET, neuromas, or neurofibromas. Granulomatous appendicitis may be another cause of recurrent appendicitis due to a variety of cases, tuberculosis being one of them and antitubercular therapy being the mainstay of treatment for these cases. Xanthogranulomatous appendicitis may simulate colonic malignancy, Crohn’s disease, malakoplakia, etc. Histopathological features are the main diagnostic modalities for these instances. Pinworm is a common helminthic infection of the gastrointestinal tract. Currently, its incidence is on the declining side due to better sanitation practices. However, it must be reported in appendectomy sections, if present, to initiate a course of antihelminthic drugs. Pseudomyxoma peritonei is an uncommon entity classically characterized by mucinous ascites resulting from ruptured appendiceal mucinous tumors, one such rare case being reported here. Low-grade appendiceal mucinous neoplasm is a distinctive entity rarely seen in appendectomy cases, belonging to groups of appendiceal mucinous neoplasms. One such instance has been depicted here.
Non-invasive ventilation using RAM’S cannula in neonates-what difference does it make?
Authors: Anjuri Sharma  , Monica Lazarus  , Asha Tiwari  , Lalit M Malviya  , Vidya K Saurabh
Published: January 2025

Background: Neonates undergo transition at birth from breathing fluid to breathing air. If this change is not tolerated by neonate, need of assisted ventilation arises. Non-invasive ventilation (NIV) refers to any mode of respiratory support provided through nasal airway. Using RAM’S cannula as an interface, complications of invasive ventilation can be prevented, and therefore it can be impactful in improving respiratory care in neonates.
Aims and Objectives: The aim of the study was to find the association of clinicoetiological factors and the outcome of NIV using RAMS’s cannula in neonates.
Materials and Methods: This prospective observational study was done from March 1, 2021 to August 31, 2022 at Neonatal Intensive Care Unit of a Tertiary care center in Central India. Neonates given NIV through Ram’s cannula were enrolled. Primary diagnosis of subjects and clinical parameters - birth weight, gestational age, duration of NIV given, and severity of respiratory distress were recorded and analyzed to find an association with the outcomes. Informed consent was obtained from parents.
Results: 100 neonates (62 male) were given NIV. 78 neonates were weaned off from NIV and 22 needed intubation. Duration of NIV, gestational age, severity of respiratory distress, and birth weight were found to be statistically significant. Weaning was more in gestation >34 weeks, weight >1 kg, duration of NIV given <3 days, and neonate having mild respiratory distress.
Conclusion: NIV through RAM’s cannula is useful in both respiratory and non-respiratory illness. Higher rates of NIV failure were seen in the duration of NIV >7 days, weight <1 kg, and gestation <34 weeks.
To compare the efficacy of intrathecal 0.75% heavy ropivacaine and 0.5% heavy bupivacaine for lower abdominal and lower limb surgery
Authors: Harshad Mangaldas Mahajan  , Sandipbhai Jivanbhai Patel
Published: January 2025

Background: Spinal anesthesia is the most popular regional anesthesia technique for lower limb and lower abdominal surgery. Bupivacaine 0.5% heavy is commonly used for intrathecal use. New long-acting local anesthetic agents such as ropivacaine have claimed benefits of reduced cardiac toxicity on overdose and more specific effects on sensory rather than motor nerve fibers. The use of intrathecal hyperbaric ropivacaine is not much studied. With this background, we studied intrathecal ropivacaine hyperbaric 0.75% against intrathecal bupivacaine hyperbaric 0.5% for lower abdominal and lower limb surgery.
Aims and Objectives: To note the effectiveness of intrathecal ropivacaine and bupivacaine on characteristics of subarachnoid block such as sensory block, motor block, hemodynamic parameters, and complications if any.
Materials and Methods: We randomized patients undergoing lower abdominal surgeries and lower limb orthopedic surgeries under spinal anesthesia into two groups so as to receive intrathecal either ropivacaine 0.75% hyperbaric (3 mL) or bupivacaine 0.5% hyperbaric (3mL) and noted study parameters.
Results: Time of sensory block onset (P=0.0005), peak sensory level (P=0.0029), and onset of L1 bromage-3 motor block (P=1.27E–08) was significantly delayed in the ropivacaine group as compared to bupivacaine group. However, maximum sensory level achieved (T6), time required for two-segment sensory regressions (P=0.1162), and time of onset of pain (P=0.1162) were comparable in both groups.
Conclusion: Intrathecal ropivacaine 0.75% hyperbaric produced slow onset sensory and motor block than 0.5% hyperbaric bupivacaine with comparable cephalic spread and duration of sensory block.
Evaluation of thyromental distance versus tongue width versus weight-based method for size determination of laryngeal mask airway in adults
Authors: Shalini Jain  , Priyanka Joshi  , K K Arora
Published: January 2025

Background: Supraglottic airway devices (SGD) are indispensable for airway management. The successful placement of the laryngeal mask airway (LMA) supreme largely depends on the right size selection.
Aims and Objectives: The study was undertaken to compare three LMA supreme insertion methods in short elective surgeries under general anesthesia.
Materials and Methods: Atotal of 90 American Society of Anesthesiologists I and II patients (either gender, 18–55 years, Mallampati grade I and II) undergoing short surgeries were randomized into three equal groups (n=30 in each). Insertion of LMA was done after an adequate depth of anesthesia for jaw relaxation (Young’s criteria). The efficacy of controlled ventilation through LMA by each method, success rate, ease of insertion, insertion time, additional induction dose (propofol) required during insertion, hemodynamic stability (baseline vitals and 10 min after insertion), and adverse events after LMA removal were evaluated between groups.
Results: Better ventilation (tidal volume at 10 cmH2O) was observed in the thyromental group (448±35) than in tongue width (440±46) and weight-based (409±33) groups. Minimum additional propofol requirement during insertion was in thyromental distance group. Thyromental distance group had the most easy LMA insertions (70%) with minimum insertion time (10±4) and minimum additional propofol requirement during insertion (P<0.05) than other groups. Overall hemodynamic stability and incidence of adverse events were comparable.
Conclusion: Thyromental distance may be an alternative attractive choice for size determination of LMA supreme in female adults with normal airway anatomy in comparison to tongue width and conventional body weight-based methods.
A comparative analysis of computed tomography and ultrasonography in diagnosis of neck masses
Authors: Mohd Aqib  , Zohda Tayyaba  , Abdur Rahman  , Sharma SC  , Mohd Aftab
Published: January 2025

Background: Neck swellings constitute the chief complaint of many patients coming to ENT outpatient department. Adequate evaluation of all cases with assistance from radiological, cytopathological, and histopathological is necessary.
Aims and Objectives: The present study aims to evaluate the role of clinical, radiological, and cytopathological evaluation to reach the diagnosis and the accuracy of these tools.
Materials and Methods: The study was conducted in the Department of Otorhinolaryngology and Head and Neck Surgery and the Department of Radiodiagnosis, AMU, and included 100 patients with neck swelling.
Results: Maximum number of patients were of lymph node masses (44%), followed by thyroid masses (26%) and salivary gland pathologies, congenital neck masses, and others. 78% were benign masses while only 22% were malignant. Out of all cases, the maximum were reactive lymphadenitis (16%), followed by metastatic lymph nodes (12%) and pleomorphic adenoma (10%). The correlation between clinical diagnosis and ultrasound (USG) was 70.93 with a diagnostic accuracy of 86%; with fine-needle aspiration cytology (FNAC) accuracy being 82%. 91% of metastatic lymph node swellings were accurately diagnosed by these two modalities alone. The sensitivity and specificity of FNAC with computed tomography (CT) were 62.25% and 98.59%, respectively; while with biopsy were 84.63% and 97.10%.
Conclusion: Clinical evaluation remains the utmost important step in the management of patients with neck swellings. USG provides the necessary information to guide further management, followed by FNAC. Although CT and histopathological evaluation provide detailed information, it was rarely needed in our study to reach the clinical diagnosis however their need in the management of pathology could not be ruled out.
Alice in wonderland syndrome – A medical enigma
Authors: Pushpa NB  , Dyuksah Arora  , Kumar Satish Ravi
Published: January 2025

Alice in Wonderland syndrome (AIWS) is a disorder in which patients report distorted visual perception and an impaired sense of time. It was first described in 1955 by the British psychiatrist John Todd, who associated these symptoms with disorders such as migraine and epilepsy. Before Todd’s observations, many symptoms of this disorder had made appearances in literature describing hysteria. Similar symptoms were observed in soldiers with occipital wounds after World Wars I and II.
Patients with AIWS experience a plethora of symptoms such as, “kinetopsia” – Stationary objects appear to be moving, “total microsomatognosia” – Body parts appear unusually smaller. “Depersonalization” – Feeling of strangeness in perceiving one’s body image is common in AIWS. Often, this is accompanied by “derealisation” – Patients start perceiving their surroundings and the people around them as unreal. However, the patient is aware that this state of consciousness is not normal- which is what differentiates it from the state of psychosis. Other symptoms include: Dyschronometria, dysmorphops, macropsia, micropsia, kinetopsia, prosopometamorphopsia, and plagiopsia. In migraine patients, the prevalence rate of these symptoms increases to about 15%.
Most symptoms of AIWS are ascribed to neurons of the central nervous system and cell columns that respond to specific sensory inputs (Ex- like visionary inputs of cortical areas V1–V5). Area V4 of the extrastriata visual cortex, particularly responds to the colors, whereas area V5 responds to movement. V4 and V5 also respond to shape and depth, but the bilateral loss of function of V4 results in achromatopsia (the inability to visualize color), and bilateral loss of V5 results in akinetopsia (the inability to visualize motion).
Anatomically speaking, a critical region for developing this syndrome is the junction of three major areas, i.e., temporooccipital, parieto-occipital, and temporo-parietal junctions, known as the temporoparietal-occipital carrefour, point where our visual and somatosensory perceptions of the world are integrated to develop an external and internal representation of ourselves.
AIWS remains a poorly understood and usually misdiagnosed syndrome. It is mostly associated with Epstein–Barr virus infection in children. Most cases of AIWS are expected to have a full remission of symptoms; sometimes, this may occur spontaneously with/without proper treatment. However, in cases with an associated chronic disease, like migraines and epilepsy, symptoms tend to occur in accordance with the active phases of these diseases.
The number of fascinating disorders that surround and confound the medical community has no limit. The journey into the human brain is about as daunting and baffling as Alice’s journey into Wonderland. Efforts to understand the functioning and physiology of this extraordinary organ will keep both doctors and scientists on their toes for many years to come.
Position of oral cephalosporins and its fixed-dose combinations in the guideline recommendations for the management of community-acquired infections
Authors: Mala Kaneria  , Ilambarathi M  , Vishal Singh  , Varun N  , Rashmi Hegde  , Praveen Kamble  , Krunal Dalal
Published: January 2025

Community-acquired infections (CAIs) represent a major burden for health-care system. This directly aids the emergence of antibiotic-resistant organisms. India is not immune to it. This review assessed the current guideline recommendations for the usage of oral cephalosporins in the management of common CAIs. The researchers conducted iterative searches in PubMed, SCOPUS, and Google Scholar for published articles using various keywords. The search was conducted in November 2022 and considered articles published till date. Different CAIs are caused by similar organisms, susceptible to first-line antibiotics such as penicillin and cephalosporins. Most of the guidelines recommend the use of oral cephalosporins for the management of the commonly prevalent CAIs. These antibiotics however should be used as a monotherapy and not as fixed-dose combinations (FDCs), as FDCs with oral cephalosporins lack scientific basis and may be detrimental. For burden of CAIs intensified by anti-microbial resistance, guidelines are useful for the management of CAIs to educate the prescribers and preserve currently available antibiotics.
SEM study of resin tags depth for filled pit and fissure sealants using subpressure and adhesive system - An experimental analysis
Authors: Sonali Waghmode  , Shashikiran D  , Savita Hadakar  , Namrata Gaonkar  , Sachin Gugawad
Published: January 2025

Background: Pit and fissure caries account for about 90% of the caries of permanent posterior teeth and 44% of caries within the first teeth in children and adolescents. Sealant application may be a preventive conservative approach. However, it is still challenging to bolster the retention of the filled sealant and to chop back the microleakage.
Aims and Objectives: To evaluate and compare the depth of resin tags of three filled pit and fissure sealants (PFS) using subpressure and adhesive system under scanning electron microscope (SEM).
Materials and Methods: This study was in vitro experimental study. Forty-five orthodontically extracted premolars were prepared for resin tag depth measurement and divided according to materials and subgroups. Group A- Resin-based filled PFS, Group B- Resin modified glass ionomer-based filled PFS, Group C- Giomer based filled PFS. Subgroup 1- Only sealant application, Subgroup 2- Subpressure application, Subgroup 3-Adhesive system + Subpressure application. Samples were subjected to thermocycling. The sectioned tooth fragments were polished using a carbide stone and then mounted under SEM for analysis. Photographs of the sections were obtained and the resin tag lengths were measured. Unpaired t-test and one-way analysis of variance test used for analysis. Results were considered significant when P<0.05.
Results: The depth of resin tags of the tested materials differed significantly for Giomer-based and resin-modified glass ionomer-based filled PFS group with P<0.05. Whereas Resin-based filled PFS group was not found significant P>0.05 for the depth of resin tags.
Conclusion: This study concludes that Giomer based filled PFS group and Resin-modified glass ionomer-based filled PFSs showed the highest Resin tag depth respectively when compared with Resin-based filled PFSs. The Subpressure application group was more effective followed by Adhesive+subpressure application group and Control group.
Comparative study between the effect of dexmedetomidine and lidocaine infusion on intraoperative analgesic requirement and hemodynamics during craniotomy
Authors: Agnimitra Ghosal  , Tanay Debnath  , Soma Chakraborty  , Debojyoti Das  , Arpita Laha  , Mohanchandra Mandal  , Amita Acharjee
Published: January 2025

Background: Nowadays, anesthesiologists are evaluating several analgesic adjuncts to minimize opioid use during craniotomy. Some studies have evaluated the analgesic-sparing effect of intravenous infusion of dexmedetomidine and lidocaine on intraoperative hemodynamics and post-operative analgesia. There is a paucity of studies focussing on the intraoperative analgesic requirement.
Aims and Objectives: The present study compared dexmedetomidine and lidocaine infusion primarily for their effects on intraoperative fentanyl requirements during craniotomy.
Materials and Methods: This study was done on 70 patients aged 18–80 years, the American Society of Anesthesiologists physical status I–II, having Glasgow Coma Scale 15, undergoing craniotomies. Patients were randomly allocated to receive either dexmedetomidine (group A, n=35) at a dose of 0.6 mcg/kg bolus over 10 min followed by 0.6 mcg/kg/h infusion or lidocaine (group B, n=35) at a dose of 1.5 mg/kg bolus over 10 min, followed by 1.5 mg/kg/h infusion till the end of skin suture, respectively. Study drugs were started 10 min before the start of surgery. Intraoperative total fentanyl and propofol consumption, intraoperative hemodynamics, recovery from hypnosis, and time to extubation were recorded.
Results: The use of dexmedetomidine resulted in considerably less total fentanyl requirement (245.1 vs. 300.7 mcg, P<0.0001) and total propofol requirement (172.7 vs. 236.7 mg, P<0.0001) compared with lidocaine. Comparatively better hemodynamics were observed with the use of dexmedetomidine at all the points of observation.
Conclusion: Dexmedetomidine as an analgesic adjunct can be a better alternative to lidocaine in terms of reduced fentanyl consumption, reduced propofol use and favorable hemodynamics, and early recovery from anesthesia.
Adverse drug reaction monitoring of commonly prescribed antimicrobial agents in patients at Rama medical college, hospital and research centre, Kanpur
Authors: Princ Bgheal  , Piyush Verma  , Bhopal Chandra Vurimi  , Nilam Nigam  , Kriti Jalota  , Syed Shadman Ahmad  , Priyanka Pal  , Anjani Devi Nelavala
Published: January 2025

Background: An adverse drug reaction (ADR) is defined as a harmful or unpleasant reaction due to the use of a drug and may cause different types of effects, such as side effects. The World Health Organization states that adverse drug effects are a response to harmful and unintended medicine and occur at doses normally used in men for the prevention, diagnosis, or therapy of disease or for modifying physiological function.
Aims and Objectives: The objective of the study was ADR monitoring of commonly prescribed antimicrobial agents.
Materials and Methods: The study was conducted at Rama Hospital and the Research Center Mandhana Kanpur. Data were collected from the patients attending the outpatient and inpatient departments (OPD and IPD) of the medicine departments during the study period at Rama Hospital Mandhana, Kanpur. The sample size was a total of 60 patients. The study duration was conducted for 1 year. Data were collected by analyzing OPDs and IPDs in the Department of Medicine.
Results: There are different types of adverse drug effects; we observed only three types of adverse drug effects in this study. The most commonly observed ADR was type A (56.66%). Out of the total ADRs reported in antimicrobial agents, skin ADRs (42.02%) and gastrointestinal tract ADRs (57.97%) are higher. There are also three different types of severity conditions observed in patients prescribed antimicrobial drugs; among them, the most commonly observed severity conditions were mild (58.33%).
Conclusion: These study findings suggest that antimicrobial drugs are generally safe for most patients but can cause mild ADRs. It is important to monitor patients for ADRs while taking antimicrobial drugs and to provide appropriate treatment if necessary. Pharmacovigilance programs can help to identify and monitor ADRs, which can lead to improved patient safety.
The demographic profile, clinical spectrum, and outcome of term neonates requiring continuous positive airway pressure in a tertiary care teaching hospital
Authors: Salib Hamid  , Suhail Ahmad Naik  , Shafat Tak
Published: January 2025

Background: Respiratory distress is the major cause of neonatal intensive care unit (NICU) admission of full-term neonates for which they require different levels of mode of ventilation.
Aims and Objectives: The objective of this study was to determine the demographic profile, clinical spectrum, and outcome of term neonates, requiring continuous positive airway pressure (CPAP) in tertiary care teaching hospitals.
Materials and Methods: The study was a prospective observational study conducted from December 2020 to November 2022 in the neonatal section of the department of pediatrics.
Results: A total of 261 neonates were included in the study. The male-to-female ratio was 1.7:1, the range of birth weight was between 2.1 kg and 3 kg (60.91%), the gestation age was 38 weeks (59.2%), and 73.6% were lower-segment cesarean section born. The age of starting CPAP in most of the newborns was at admission to NICU (in 69.73% of cases). The success rate of CPAP therapy was high (60.9%) and the rest 39.08% of patients did not settle with CPAP and required higher modes of respiratory support such as nasalintermittent positive pressure ventilation (IPPV) (5.89%) and IPPV (94.11%).
Conclusion: In the resource-limiting settings, due to the non-availability of higher levels of ventilatory gadgets, the early use of CPAP as a mode of ventilation in full-term babies with transient tachypnea of newborns is well-documented and it can be safely used in other common neonatal conditions which can cause respiratory distress in full-term neonates. The low-middle-income countries are facing challenges to improve comprehensive neonatal care; there is a dire need for simple and cost-effective methods of respiratory support. Bubble CPAP is one such promising ventilatory support intervention, which may reduce the need for costly mechanical ventilators.
Nalbuphine as an adjuvant to bupivacaine in ultrasound-guided brachial plexus blockade: A meta-analysis of randomized and controlled trials
Authors: Rajesh Kumar  , Apoorva Jaiswal
Published: January 2025

The brachial plexus block is a flexible and reliable regional anesthetic method with a wide range of applications. In this study, we aim to determine whether nalbuphine in combination with the local anesthetic bupivacaine could increase the efficacy and duration of analgesia during ultrasound-guided blockade of the brachial plexus. Seven randomized and controlled trials involving 416 patients were included after searching PubMed, Google, and Web of Science. Results of the studies were then retrieved and effect sizes were calculated using Review Manager 5. Duration of analgesia was significant heterogeneity between studies (P<0.00001, I2=96%). A random-effects model was used, and there was significant heterogeneity between studies in the duration of analgesia. A significant difference was found between groups (standard mean difference [MD] 6.27, confidence interval [CI] [4.40–8.60], P<0.001). Duration of motor block was also significant heterogeneity between studies (P<0.00001, I2=98%). A random-effects model was used, and there was significant heterogeneity between studies in the duration of motor block. A significant difference was found between groups (standard MD 6.27, CI [4.01–8.54], P<0.001). In supraclavicular brachial plexus blockade, the duration of analgesia and the duration of motor blockade can be prolonged using nalbuphine as an adjuvant with bupivacaine.
A case of cirsoid aneurysm: Case report
Authors: Jolly Sinha  , Avdhesh Shukla  , Vivek Kumar Kankane  , Avinash Sharma  , Kundan Kumar
Published: January 2025

Scalp cirsoid aneurysm is an arteriovenous fistula of the scalp that is usually unconnected by intracranial or cerebral vessels. Variceal dilatation of draining veins can produce cosmetic concerns, masses, local pain, palpable thrills, audible bruits, headache, tinnitus, and torrential hemorrhage. Its etiopathogenesis is not well understood. Treatment includes surgery (fistula repair by simple surgical ligation until gross total resection), embolization (whether percutaneous or endovascular), or a combination of the two. Here is a case report of a 40-year-old male patient who had right superficial temporal artery cirsoid aneurysm who underwent surgical ligation with complete excision of the lesion.
Costoclavicular block – single to double injection – time to see the premiere of triple injection
Authors: Priyanka Bansal  , Nidhi Sultania
Published: January 2025

Sir,Securing the phrenic nerve when achieving effective anesthesia block for the upper limb has been a topic intriguing regional anesthesia enthusiasts ever since. Interscalene brachial plexus block is known to involve the phrenic nerve in 100% of the cases and costoclavicular block which has gained momentum since 2015 is declared to involve the phrenic nerve in 0% of the cases. Besides this the compact, reliable topography of the cords in the triangular costoclavicular space along with an expedited sensorimotor block with local anesthesia deposited in the center of the three cords makes costoclavicular block an attractive option for elbow and below elbow surgeries. According to the studies, the success rate of the blockade is 92.5% with single injection in the center of the cords. Another study by Sebastian, where apart from classical single injection, another injection was given after redirecting the needle, between the medial cord and subclavian artery (labeling it a corner pocket technique) for costoclavicular block. They concluded that the block’s onset time and total anesthesia-related time were significantly shortened with the double injection technique compared with single injection. The basis of this was explanation laid by Dr. Monzo and Hadzic where they proposed in a series of 40 patients a linear septum arising from the lateral part of axillary artery separating the lateral code from the posterior and the medial code, thus compartmentalizing the costoclavicular space. They reported a success rate of 97.5% in their study on 40 patients.4 Hence,double injection is used to overcome the septum “issue.”
Pornpatra is defined a high definition ultrasonographic presence of paraneural sheath and facial compartments surrounding the brachial plexus cords at the lateral infraclavicular fossa and the costoclavicular space. We propose that a triple injection with 3rd injection in the vicinity of the lateral cord just before withdrawing the needle apart from the other two injections significantly shortens the onset time of sensory block from 16 min to 9 min. The various sites for injection are shown in the figure below, but the exact point of injection of the second and third is more prominent after giving the first injection. The chances of the median nerve sparing as has been reported in some cases in previous studies are almost nil by this technique - the corner pocket injection that involves the medial root of the median nerve and the lateral cord that is specifically blocked separately covering the lateral root of the median nerve.
CONCLUSIONWe did a case series in 15 cases and although the sample size is small and this is definitely not a randomized control trial, to make such a bold statement, we would like to decipher a positive future of the costoclavicular block with triple injection technique with an RCT already underway.
A study on normal reference values of the left ventricular strain parameters in young adults
Authors: Das Malyaban , Kuila Madhumita , Halder Swapan Kumar
Published: January 2025

Background: The left ventricular (LV) function is an important prognostic determinant of cardiopulmonary pathologies in adult. Clinical application of cardiac strain by two-dimensional speckle tracking echocardiography to measure LV function requires knowledge of the range of normal values. Reference values and associated variations of the deformation measures need to be “firmly established before routine clinical adoption” of LV strain measurements can be implemented in Indian population.
Aims and Objectives: This study aims to establish normal values of LV strain parameters in normal Indian population.
Materials and Methods: An observational, cross-sectional, single-center, hospital-based study. The study period October 2021–October 2022 in Nil Ratan Sircir Medical College, Kolkata. Cardiologically healthy adult subjects (sample size 250) both male and female, aged 18–45 years who were healthcare professionals of this medical college and hospital were included in the study. Routine history taking and investigations were done. Echodoppler was done with special emphasis on LV strain parameters.
Results: Distribution of mean LV circumferential strain (LVCS) with age in years was statistically not significant (P=0.8068). The mean value in male and female were −18.9574(±0.9049) and −19.0257(±0.8908) respectively. In the current study, LVCS did not vary in statistically significant a way among different age groups too. The mean values in male and female were −22.5887(±1.8065) and −22.3312(±1.9007) respectively.
Conclusion: This current study failed to show significant differences in LV strain parameters between age groups or male and female in Eastern India Population.
Changing paradigm of scrub typhus infection in children: A study from a tertiary care center of Eastern India
Authors: Urmimala Bhattacharya  , Sumita Pal  , Soumyadip Paria  , Basu Kaushambi
Published: January 2025

Background: Scrub typhus, a zoonotic disease, is transmitted to humans by the bite of larval trombiculid mite. Keeping in view the morbidity and mortality associated with undiagnosed cases (due to both lack of specific diagnostic tests and ignorance about the disease), the disease deserves a special mention.
Aims and Objectives: The aims and objectives of the study were to assess complications and atypical manifestations of scrub typhus fever in this subpopulation and to assess the prognosis of patients presenting with atypical manifestations/complications.
Materials and Methods: This is a longitudinal observational study on the basis of clinical and laboratory evidence at Department of Pediatrics, Calcutta-National-Medical College and Hospital, Kolkata, West Bengal, from March 2021 to February 2022. Children between >28 days and <12 years with atypical manifestations of scrub typhus who were scrub immunoglobulin (Ig)M positive (Serum and/or cerebrospinal fluid) were included in the study.
Results: Of the 120 scrub typhus IgM-positive patients admitted in 1 year, complications present in 35%. These patients developed encephalitis, encephalomyelitis, neurological deficits, myocarditis, disseminated intravascular coagulation, acute kidney injury, atypical pneumonia, acute respiratory distress syndrome, acute encephalitis syndrome (23.8%), myocarditis with/without heart failure (14.3%), and multi-inflammatory syndrome in children with/without severe acute respiratory syndrome coronavirus 2 IgG (14.2%). There is a statistically significant association between the duration of fever at admission and pediatric intensive care unit (PICU) admission, the longer the fever duration at admission, the higher the rate of complications and thus PICU admission.
Conclusion: Scrub typhus infection has expanded its various forms, presenting in various atypical manifestations alongside the common clinical features. Multiple cases of multiorgan involvement in the form of multi-inflammatory syndrome and hemophagocytic lymphohistiocytosis have been reported in the background of COVID-19 infection, alongside a significant percentage of scrub typhus infection reported in infancy. Thus, early detection is important to start intervention.
Level of high sensitivity troponin I and its correlation with hemodialysis vintage – A pilot study
Authors: Malik Saloni , Naithani Manisha , Atif Mirza Anissa , Kandari Sharon , Suman KM  , Gaurav Shekhar Sharma
Published: January 2025

Background: Renal replacement therapy (RRT) is advised in end-stage renal disease, the last stage of chronic kidney disease (CKD). RRT includes maintenance hemodialysis (MHD)/peritoneal dialysis/renal transplant. The requirement for MHD is annually escalating in India. It is important to note that over 80% of patients receiving MHD have at least one cardiac disease at the time of dialysis initiation, such as ischemic heart disease, congestive cardiac failure, and arrhythmias.
Aims and Objectives: The present study aimed to study high-sensitivity cardiac troponin I (hs-cTnI) serum level as a marker of cardiovascular injury in patients receiving MHD. It was an attempt to envisage a correlation between serum hs-cTnI and hemodialysis (HD) vintage (duration since initiation of dialysis till date).
Materials and Methods: We enrolled 40 patients. Group 1 included those who had received MHD for ≤24 months, and Group 2 included those who had received MHD for more than 24 months.
Results: We found no significant difference between the two groups’ clinical characteristics and demographic features. The pre-and post-HD serum hs-cTnI values of all patients were recorded. The serum hs-cTnI levels were found to be elevated in 34 out of 40 patients’ post-dialysis, and the result was statistically significant (P=0.0001).
Conclusion: The present study has encouraging results, with values of hs-cTnI raised in post-dialysis samples; however, the levels did not correlate with HD vintage. Further studies with larger sample sizes and longer follow-ups would provide more detailed information on hs-cTnI’s role as a marker for HD-induced cardiac damage.