bluuebunny/crossref_metadata_2025 huggingface dataset:
To study risk factors and biochemical profile of diabetic ketoacidosis patients with special emphasis on serum amylase
Authors: Keshav Singh  , Umesh Pratap Singh  , Dhiraj Kumar Soni
Published: January 2025

Background: Diabetes mellitus (DM) is a complex endocrinological disorder with altered metabolism of blood glucose. Diabetic ketoacidosis (DKA) is one of the life-threatening acute complications of DM that mainly occurs in type 1 diabetes patients, as well as in some patients with type 2 diabetes. The mortality rate associated with DKA depends on the experience of the treating hospital in dealing with this condition; thus, it is critical that patients detect DKA and get medical help as soon as possible.
Aims and Objectives: To study risk factors for DKA, clinical and biochemical profile of DKA patients. Correlation between serum amylase level, serum bicarbonate level and mean duration of hospital stay.
Materials and Methods: A cross-sectional analytical study was carried out on 100 DKA patients in the Department of Medicine, SGMH Rewa, Madhya Pradesh from January 2021 to June 2022. The data extracted included clinical presentation, precipitating factors, laboratory profile, complications, and hospitalization outcomes.
Results: Of the 100 patients admitted for DKA; 70 had type 2 diabetes (70%) and 30 (30%) were type I diabetes. The average age at the time of presentation was 48.61±19.59 years. The commonest precipitating factor was infection (38%) followed by other factors (62%). The most common clinical features at the time of presentation were altered sensorium, fever, vomiting, polyuria, polydipsia, weakness, lethargy, myalgia, headache, anorexia, abdominal pain, and orthopnea. The values for RBS, HCO3, and pH were 525.0±62.4, 12.6±2.69, and 7.14±0.31, respectively. There was no significant difference in clinical and biochemical profile of patients with type 1 and type 2 diabetes. The mortality rate was 3% and factors found to be significant predictors were comorbid condition, severity of mental status, severity of dehydration, RBS at the time of presentation, and severe acidosis.
Conclusion: The most common precipitating factors are infection and omission of insulin or irregular treatment. The most common clinical features at the time of presentation are nausea, vomiting, abdominal pain, headache, and dehydration. There is no significant difference in the clinical and biochemical profile of patients with type 1 and type 2 diabetes. The mortality rate in DKA is 3% and the most notable predictors of poor prognosis are; severity of altered sensorium, severity of comorbid condition, severe dehydration, severe acidosis, and identification and treatment of precipitating factors are more important. Patient education plays a crucial role in the prevention of DKA.
A study to assess the efficacy of local applicants to prevent complications of diabetic foot
Authors: Arvind Kumar Shukla  , Avinash Gautam  , Jujar Kapadia  , Saranshi Shrivastava  , Rahul Tayal  , Rajesh Maida  , Sagar Arora  , Ankit Chorma  , Paramhans D
Published: January 2025

Background: Diabetes is one of the most common comorbid illnesses in our community. Diabetes is associated with numerous complications related to microvascular, macrovascular, and metabolic etiologies. One of its complications in long course is diabetic foot ulcer and the associated morbidity and mortality is a major health issue.
Aims and Objectives: This study was conducted to describe the lesions we treat, study and compare outcomes and to identify measures to decrease morbidity and mortality due to diabetic foot disease.
Materials and Methods: All patients who attended general surgery outpatient department at M.Y. Hospital (M.P.) India between July 1st 2021 and June 30th, 2022 were included in this study with nonhealing Diabetic foot Ulcer Wagners Stage 3 for more than 2 weeks without any other comorbidities.
Results: Majority of the patients presented with higher grade and with poor glycemic control at the time of presentation. Conservative management with antibiotics was useful in a small subset of the patients. Majority of the patients needed surgical treatment in the form of debridement to amputations.
Conclusion: Diabetic limb disease is more prevalent in male sex commonly in 51–60 years of age group. 74% of patients presented with foot ulcer and Staphylococcus aureus was found the most common microorganism in pus culture from wounds. Local applicants are effective in controlling ulcers. In our study, hydrogel with colloidal silver was most effective followed by silver nitrate. Early and aggressive treatment of these ulcers can prevent the rate of amputation.
Serological profile of chronic hepatitis B carriers – A tertiary care experience
Authors: Swaathy Ramamurthy  , Rathinam Suresh  , Purushothaman Ganesan
Published: January 2025

Background: Hepatitis B virus (HBV) infection in India has prevalence of around 40 million chronic HBV (CHB) carriers; 1 to 2 lakhs reported deaths annually due to its complications, such as cirrhosis and hepatocellular carcinoma. Most are asymptomatic, serving as the source of this highly transmissible infection. These patients must be evaluated and monitored regularly, for prediction of their prognosis to reduce their morbidity and mortality.
Aims and Objectives: In this study, asymptomatic CHB carriers are evaluated, to assess the risk factors, and to determine replication markers of HBV and coinfection with hepatitis D virus.
Materials and Methods: In this cross-sectional study, 123 asymptomatic CHB carriers were subjected to hepatitis B serological assays such as hepatitis B surface antigen, hepatitis B “e” antigen, anti-hepatitis B “e” antibody, and anti-HDV antibody by enzyme-linked immunosorbent assay.
Results: Majority (70%) belonged to the age group of 21–50 years. Replicative carriers (HBeAg+) belonging to the age group below 40 years constituted 75% (P=0.04). The most common risk factor in the study group was frequent therapeutic injections (36.6%) followed by family contacts (33.3%). Significant part of family contacts was replicative carrier (P=0.025). Serological profile showed that 83.3% were HBe-seroconverted, with only16.2% showing HBeAg positivity. No patient showed co/super-infection with HDV.
Conclusion: Preponderance of hepatitis B carrier status in young adult males and four fold increased incidence in family contacts than general population necessitates stringent screening of young adults and family contacts. Furthermore, this study mandates regular evaluation of chronic hepatitis B carriers by serological assays for better therapeutic management.
A study on relationship between protein-energy malnutrition and other morbidities among under-five children in a rural area of Hooghly district, West Bengal
Authors: Tushar Kanti Saha  , Eashin Gazi  , Kallol Bhandari
Published: January 2025

Background: Malnutrition affects physical growth, morbidity, and mortality of the under-five children. It is an underlying factor in many diseases for children and is particularly prevalent in developing countries, where it affects one out of every three preschool-age children.
Aims and Objectives: The aims of this study were to find out the relationship between protein-energy malnutrition and other morbidities among under-five children.
Materials and Methods: Community-based prospective longitudinal study was conducted in 1 year duration in a rural area of Hooghly District, West Bengal. By adopting sample size calculation formula 4 pq/L2, total 108 children were participated in the study. With the help of pre-design, pre-tested schedule data were collected by interviewing the care giver, by clinical and anthropometry examination of the children and by record review.
Results: Among the study population under-weight, stunted, and wasted were 52%, 37%, and 28%, respectively, whereas malnutrition by all types of classification was 61%. Episode of diarrhea, acute respiratory infections (ARI), and worm infestation were 3.50, 4.12, and 1.38/child/year, respectively. Study shows that rate of total morbidities and prevalence of malnutrition was very much interrelated.
Conclusion: Prevalence of malnutrition along with diarrhea, ARI, and worm infestations is common ailments among rural population. Special emphasis should be given for provision of health-care services and promotion and protection of optimal infant feeding practices for the improvement of nutritional as well as health status of the children.
Ocular complications and factors affecting visual outcome in herpes zoster ophthalmicus: A prospective study in a tertiary care teaching hospital, Telangana, India
Authors: Babu Manda  , Porika Ram Mohan Lal
Published: January 2025

Background: Herpes zoster ophthalmicus (HZO) is caused by varicella zoster virus and affects the ocular branch of the trigeminal nerve.
Aims and Objectives: To investigate the ocular complications and factors affecting visual prognosis in patients with HZO, a Varicella zoster virus infection affecting the ocular branch of the trigeminal nerve.
Materials and Methods: 40 patients meeting the criteria were enrolled in the study, which was conducted at the Department of Ophthalmology, SVS Medical College, Mahbubnagar, Telangana, India.
Results: The study found that more than 50% of HZO patients experienced ocular involvement, and acute corneal lesions, such as punctate and dendriform keratitis, uveitis, and severe post-herpetic discomfort, were associated with lower visual acuity. However, none of the patients in the study experienced posterior segment HZO problems such as acute retinal necrosis or progressive outer retinal necrosis. Older age groups were found to be more likely to experience post-herpetic neuralgia (PHN), which was also associated with nasociliary nerve involvement and vision loss.
Conclusion: The study suggests early treatment with tricyclic antidepressants to aid in the early resolution of PHN. In addition, the study aimed to evaluate the effect of HIV/AIDS on ocular complications in HZO patients but did not report any findings in this regard.
A randomized comparative study to estimate the safety and effectiveness between laryngeal mask airway supreme and I-gel in patients undergoing elective surgeries
Authors: Kaushal Kabir  , Keshav Middha  , Arora KK  , Aseem Sharma
Published: January 2025

Background: Supreme laryngeal mask airway (SLMA) and i-gel airway devices are second generation supraglottic airway devices (SAD) and are good alternatives to intubation during elective surgeries.
Aims and Objectives: This study was conducted with the objective of comparing the two SAD with respect to ease of insertion, number of attempts of insertion, insertion time, ease of gastric tube insertion, accompanying hemodynamic changes, incidence of adverse effects like regurgitation, lip and dental trauma, post-operative sore throat, dysphagia, and hoarseness.
Materials and Methods: This study was conducted at M.G.M. Medical College and M.Y. hospital, Indore. Eighty patients belonging to ASA class 1 or 2, with Mallampati grading 1 or 2, between age group of 18–60 years and with BMI <30 kg/m2 were selected for the study. After induction of anesthesia, one of the SAD’s (SLMA or i-gel) was inserted following randomization, and accordingly, the patients were divided into two groups of 40 each. Insertion parameters, hemodynamic, and respiratory parameters were noted. Patients were also observed for any possible complication at 1 h and 24 h postoperatively.
Results: The Two groups showed no statistically significant difference in terms of demographic characteristics, insertion parameters, hemodynamic, or respiratory parameters (P>0.05). Postoperatively, no significant complications were observed in terms of dental injury, laryngospasm. Ease of gastric tube insertion was found to be more in SLMA group than i-gel and the difference was statistically significant (P=0.0057). Incidence of sore throat after 1 h was found to be more in SLMA group than i-gel group (P=0.048).
Conclusion: There was no significant difference between SLMA and i-gel in terms of insertion characteristics and hemodynamic changes. Ease of gastric tube insertion was found to be significantly more in SLMA group than i-gel. Incidence of post-operative sore throat at 1 h was more with SLMA as compared to i-gel.
Effect of treatment of Helicobacter pylori with combination antibiotic therapy on iron deficiency anemia in patient with H. pylori-associated gastritis
Authors: Prashant Tanaji Dond  , Rahul Deshpande  , Shailesh Patil  , Naresh Bhat
Published: January 2025

Background: The failure to identify a cause of iron deficiency in a substantial subset of patients with low iron stores raises the question of whether there are additional as of yet unexplained causes of iron depletion. Recently, there has been a growing body of evidence to suggest a relationship between Helicobacter pylori gastritis and iron deficiency anemia (IDA) in the absence of peptic ulcer disease.
Aims and Objectives: Therefore, the present study was undertaken to investigate the effect of treatment of H. pylori with combination antibiotic therapy on IDA in patient with H. pylori-associated gastritis.
Materials and Methods: The present study was carried out at a tertiary care hospital catering to a large population in south Solapur and nearby areas. The study was conducted for 2 years. All patients with IDA attending outpatient department and admitted to the hospital for 2 years, were included in the present study. All patients who have IDA according to the World Health Organization criteria, as a hemoglobin concentration <13 g/dL for men and <12 g/dL for women, a mean corpuscular volume (MCV) <75 fL and a serum ferritin level < 30 ng/mL, both in-patient and outpatient setting were evaluated with detail history, clinical examination, and investigation.
Results: Baseline hemoglobin (Hb) in group I is 8.99±1.23, while in group II 7.55±2.08.All the parameters are comparable in groups I and II except baseline Hb%. There is a significant increase in Hb, packed cell volume (PCV), MCV, mean corpuscular hemoglobin (MCH), and MCH concentration (MCHC) after 2 months of treatment with oral iron therapy. There is a significant increase in Hb, PCV, MCV, MCH, and MCHC after 2 months of treatment with oral iron and triple therapy for H. pylori.
Conclusion: Treatment of H. pylori infection was associated with more rapid and significant response to oral iron therapy in IDA as compared with the use of iron therapy alone.
Clinicopathologic study of triple-negative breast cancer with special reference to basal-like breast cancer phenotype in a tertiary care hospital of Eastern India
Authors: Rajashree Pradhan  , Sajeeb Mondal  , Mrinal Sikdar  , Sankha Chatterjee
Published: January 2025

Background: Triple-negative breast cancer (TNBC) is defined as absent expression of estrogen receptor (ER) and progesterone receptors and human epidermal growth factor receptors (HER2neu). These cancers are associated with poor prognosis.
Aims and Objectives: We aimed at to study the clinicopathological profile and survival among women with TNBC.
Materials and Methods: The study was conducted over a period of 4 years. Surgical specimens of patients with breast cancer were analyzed histopathologically as well as immunohistochemical analysis for estrogen, progesterone, HER2neu, and Ki-67 index was also done. Statistical analysis was done using software version 20.0. Results were expressed in number and percentage. Comparison was done by x2 test. P=0.05 was considered statistically significant.
Results: In our study, 26.92% cases were of TNBC. Predominant age group affected was between 50 and 70 years. Most common histologic type was invasive carcinoma of no special type with higher grade (Grades 2 and 3) mostly with frequent nodal metastasis. Higher percentage of Ki-67 proliferation index and basal cytokeratin expression were associated with higher tumor grade and stage along with reduced short-term disease-free survival on follow-up.
Conclusion: TNBCs are usually of higher grade with frequent recurrences and distant metastasis. There are no widely accepted prognostic markers available. Panel of immunohistochemical markers should be used specially to categorize the basal-like breast cancer subtype among TNBCs for better clinical outcome.
Gastric lavage to reduce feed intolerance among vigorous neonates >34 weeks born through meconium stained liquor: A comparative study
Authors: Manoj Kumar Gupta  , Dhirendra Prasad Yadav  , Mohammad Ashfaque Ansari  , Mukendra Sah
Published: January 2025

Background: Feed intolerance during early postnatal period is common in newborns with meconium-stained liquor (MSL). Prophylactic gastric lavage in neonates delivered with MSL and its recommendation by some pediatric textbooks, despite negligible scientific evidence and evidence-based recommendations.
Aims and Objectives: This study was designed with the objective of determining if gastric lavage in all babies with MSL led to the development of less feed intolerance as compared to those who were not subject to the procedure.
Materials and Methods: The present study was a randomized control trial, conducted at National Medical College and Teaching Hospital, Birgunj, from December 01, 2021, to November 30, 2022. The study populations were 280 vigorous neonates with ≥34 weeks of gestation and ≥1800 g delivered with MSL. Among them, 140 neonates were kept in the lavage and non-lavage group. Data were analyzed using the Chi-square test, odds ratio, and level of significance at P<0.05.
Results: Thirty-two (22.85%) and 54 (38.57%) neonate in the lavage and no lavage group developed the first episode of vomiting with a significant P=0.005. No significant difference in the incidence of feed intolerance was found (8.57% vs. 15%, P=0.099). None of the neonates in either group developed any complications during the procedure.
Conclusion: Gastric lavage seems to reduce the first episode of vomiting but not overall feed intolerance in vigorous infants born through meconium-stained amniotic fluid. Hence, concluded that gastric lavage should be reserved for treating the rather rare feed intolerance than routine prophylactic in vigorous neonates delivered with MSL.
Comparison of 2 doses of 1% 2-chloroprocaine as spinal anesthetic for perineal and lower-limb surgeries
Authors: Purva Kumrawat  , Vanjare Hemant , Rajesh SR  , Shankarnarayana P  , Jitendra Singh Zilwe
Published: January 2025

Background: Spinal anesthesia is a commonly employed anesthetic technique for infraumbilical surgeries. Some of its properties may limit its use for ambulatory surgery. For outpatient surgery, lignocaine was anesthetic of choice for years, but its use has been associated with significant risk. Short-acting local anesthetic may therefore represent a valid alternative in this setting.
Aims and Objectives: We compare the duration of action of sensory and motor block with 40 mg and 50 mg preservative-free 1% 2-chloroprocaine (2-CP), as a subarachnoid block.
Materials and Methods: Patients posted for surgery were randomized to two groups A and B with 64 patients in each group to whom, 40 mg and 50 mg preservative-free 1% 2-CP was administered as spinal anesthesia, respectively. After completion of spinal injection onset time, evolution of sensory and motor block and vitals were studied.
Results: The median onset time was 4 min for both 40 mg and 50 mg 1% 2-CP. The duration of sensory block with 40 mg 2-CP was 117 (74–168) and with 50 mg 2-CP was 148 (116–176) min. The duration of motor block with 40 mg 2-CP was 104 (60–150) and with 50 mg 2-CP was 134 (106–158) min. In terms of hemodynamic parameters and adverse effects, there was no statistically significant difference found between both groups.
Conclusion: Our study revealed that 40 mg of 1% 2-CP produces a satisfactory surgical block for procedures lasting <90 min. When compared with 1% 2-CP 50 mg, it resulted in comparable onset of action, with significantly faster regression of the block, shorter time to ambulation.
Perfusion index as a predictor of hypotension following induction of general anaesthesia with propofol-An observational study
Authors: Rithwik K Rajeev  , Aswathy S  , Yedudev S B  , Vrinda M
Published: January 2025

Background: Perfusion index (PI) is a somewhat novel parameter evaluating the pulsatility of blood in the extremities, calculated using the infrared spectrum as a component of plethysmography waveform processing.
Aims and Objectives: To obtain a cutoff value of pre-anesthesia PI, which may be helpful for the prediction of hypotension following anesthetic induction with propofol.
Materials and Methods: This descriptive observational research was carried out at the Sree Gokulam medical college and research foundation, Venjaramoodu, Trivandrum, Kerala, from June 2020 to June 2021. A total of 174 patients of age group 17–60 years, with ASA 1 or 2 scheduled for surgery under general anesthesia, were included. The parameters (systolic blood pressure [SBP], diastolic blood pressure, mean arterial pressure, PI, and SPO2) were recorded until 5 min of induction. Intravenous (IV) fentanyl 2 μg/kg was administered, propofol injected was given slowly at a rate of 10 mg per every 5 s, titrated to loss of verbal communication responseuronium 0.1 mg/kg IV was administered. The calculation for hypertension was done 5 min after anesthesia. The predictive validity of PI was calculated, keeping SBP as the standard gold test. For statistical analysis coGuide software.
Results: The cutoff value for PI at 5 min was low (≤2.45) for 27 (90%) participants and high (>2.45) for 3 (10%) participants. With a sensitivity of 90% in predicting hypotension and specificity of 87.50%, false-positive rate was 12.50%, false-negative rate was 10, positive predictive value was 60% (95 CI 44.43–74.30%), the negative predictive value (NPV) was 97.67%, and the total diagnostic accuracy was 87.93%.
Conclusion: With the current study’s findings, we conclude that PI cutoff value 2.45 can be used to predict hypotension following anesthetic induction with propofol. It has a high NPV with fair diagnostic accuracy.
Safety and efficacy of 30% hydrogen peroxide in seborrheic keratoses – A prospective and interventional study
Authors: Shaik Noushin  , Breethiga Velusamy  , Mohan Krishna Reddy Thotli  , Thirupathi Usha Rani  , Angidi Sushrutha  , Madine Makarand
Published: January 2025

Background: Seborrheic keratosis (SK) is a skin condition affecting the keratinocytes. Although various treatment options are available, the need for a simpler topical treatment approach is unmet. Hydrogen peroxide (HP) acts by forming free radicals and initiates apoptosis in cells.
Aims and Objectives: The aim of this study was to evaluate the safety and efficacy of 30% HP in SK.
Materials and Methods: This study was conducted on patients attending the Dermatology, Venereology, and Leprology at MGM Hospital attached to Kakatiya Medical College, Warangal and Government Medical College Mahabubabad, Telangana, during the period from December 2019 to May 2021. In total, 80 adult patients with SKs were enrolled. The study was approved by the Research Ethics Committee of the MGM Hospital attached to Kakatiya Medical College. This is a prospective and interventional study. Eighty patients will be treated with 30% of HP topically. A photographic record of the pre- and post-treatment appearance of lesions was maintained. Physician’s lesion assessment (PLA) score was evaluated on day 15th and 106th day after treatment. Local skin reactions (LSRs) were divided into mild, moderate, and severe categories. LSR was observed immediately after 2 weeks and 106 days of treatment.
Results: Most of the patients were of middle to elderly age group. SK lesions were most common seen over the head and trunk. The dermatosis papulosa nigra variant was the most common. PLA 0 was observed by day 15 in some patients after application. Of 30% HP, faster healing rates were observed in lesions over the face, and middle aged.
Conclusion: About 30% HP is a promising option for the treatment of SK.
Method comparison: Statistical measurement correlation or agreement-most appropriate tool?
Authors: Rachna Agarwal  , Chandra Bhushan Tripathi  , Puja Kumari Jha
Published: January 2025

In laboratory, a reliable method is very important to report precise and accurate results which are very important for clinical diagnosis and management decisions. In case the existing method needs to be replaced by new method due to poor results or financial issues, method comparison of a new measurement system/method with an established/referral method is required to see whether they agree sufficiently for the new to replace the old method or use the two interchangeably. Most commonly Pearson’s product-moment correlation is used to ascertain whether two methods agree sufficiently so that the old method can be replaced by a new method. However, it is the most inappropriate method with number of limitations. In this paper, other methods are discussed with their merits and demerits with examples.
Surgical management of renal calculi in cases of crossed renal ectopia: A rare case series
Authors: Periasamy Ponnusamy  , Senthil Kumar K  , Tamilselvan D  , Shreyas MD
Published: January 2025

Crossed renal ectopia is a rare congenital malformation. Only 36 cases of crossed renal ectopia with calculus have been recorded in literature, even a few cases of urolithiasis in them have been surgically managed. The majority of cases in literature have been published as single case reports. We conducted a retrospective study of all the crossed renal ectopia cases admitted and managed in our department in the past 2 years. Among them, only one was without fusion. Youngest patient was 32-year-old male with crossed left kidney with calculus in the left kidney. Both the patients underwent retrograde intrarenal surgery (RIRS). Oldest patient was 80-year-old female with a right crossed kidney with pelvic calculus, who underwent open pyelolithotomy. Post-operative period was uneventful in all cases with complete stone clearance. Patients undergoing RIRS had less post-operative pain and were discharged early compared to open pyelolithotomy. RIRS is a safe and effective modality of treatment and can be considered as the first choice for the management of calculus in crossed renal ectopia in properly selected cases. However, in cases of huge stone burden and difficult anatomy, laparoscopic/open pyelolithotomy is still an attractive option for clearing the stone in a single setting, even though it has comparatively more morbidity and longer hospital stay.
Study of correlation between arches of foot and lower back pain in Eastern India
Authors: Sounak Dasgupta  , Rajarshi Datta  , Rajasri Chunder  , Arpita Sarkar  , Sayantani Majumdar  , Arpita Layek
Published: January 2025

Background: Low back pain is one of the most common disorders of the musculoskeletal system, leading to impaired function and decreased quality of life in many patients. Foot arch alterations may lead to structural changes and/or affect its load distribution. It should be noted that even slight elevations of the foot’s medial longitudinal arch above the norm may lead to changes in load and pressure distribution. Hence, it becomes important to find the relationship between low back pain and altered foot arch indices leading to improper body balance.
Aims and Objectives: The aims and objectives of the study are to find any correlation between lower back pain and an altered foot arch index in the Eastern Indian population.
Materials and Methods: A total of 60 subjects aged 20–40 years with varying degrees of low back pain were selected. Low back pain scores of the subjects were found using modified oswestry low back pain disability questionnaire. Footprints in standing position using ink were taken on graph paper and the foot arch indices were calculated.
Results: 54.16% of the male and 36.11% of female participants had low arched feet, 20.83% of male and 52.78% of female participants had normal arched feet, and 25% of male and 11.11% of female participants had high arched feet with varying degrees of low back pain. 77.42% of the participants with minimal disability due to low back pain were having normal arched feet, 71.43% of the participants with moderate disability due to low back pain were having low arched feet, and 100% of the participants with severe disability due to low back pain were having either high or low arched feet.
Conclusion: This study showed that people having either low or high arched feet are at an increased risk of developing acute or chronic low back pain at some stage in their lives. Knowledge of this risk factor might even help people to choose appropriate occupations in the future.
Clinicoradiological, pathological, and surgical outcome in patients with tethered cord syndrome: A prospective study
Authors: Sridham Sutradhar  , Anand Sharma  , Avinash Sharma  , Harsh Deo Pandey  , Kiran Ahire
Published: January 2025

Background: Tethered cord syndrome (TCS) is a stretch-induced functional disorder of the spinal cord in which the caudal part is anchored by an inelastic structure. It is believed that, if the viscoelasticity of the filum is lost or compromised by either fatty infiltration or abnormal thickening, caudal tension and traction may cause undue stress upon the conus, resulting in TCS. It typically occurs in children, and it is rare in adults.
Aims and Objectives: The study was conducted to know the clinicoradiological, pathological, and surgical outcomes in patients with TCS.
Materials and Methods: This is a prospective observational study done in the premier institute of central India from May 2022 to April 2024. This study included patients who exhibited clinical and/or radiological features of congenital tethered cords. This encompassed both patients with tethered cord and those with TCS. Patients who failed to give consent and refused to participate in the study were excluded from the study.
Results: A total of 30 patients were recruited for the study. The median age of the patients was 6–12 months (range). The gender distribution M:F was 63.3:36.6. Based on 30 cases studied, most of the patients (75%) had improvement in urinary symptoms, 57.1% of patients had improvement in bowel symptoms, 80% of patients had improvement in pain symptoms, 75% had improvement in motor deficit, and 83.3% had improvement in sensory deficit.
Conclusion: Our prospective, cross-sectional study aimed at complete detethering of the spinal cord and the nerve roots along with excision of filum terminale and dural reconstruction to maintain adequate cerebrospinal fluid space around the spinal cord to prevent retethering.
Intramuscular ganglionic cyst in the extensor digitorum longus muscle of the leg: A case report and review of literature
Authors: Javed Ahmad  , Ajeet Kumar Yadav  , Brijmohan Patel  , Vivek Kumar Shrivastava  , Amit Kumar Rajan
Published: January 2025

Ganglionic cysts are benign soft-tissue lesions with unclear etiology and pathogenesis commonly occurring on the wrists and hands. Although their diagnosis and management in these characteristic locations are easy, rare occurrences in atypical locations are difficult to diagnose. Ultrasonography and magnetic resonance imaging (MRI) are helpful in diagnosing and differentiating a ganglionic cyst from other soft-tissue lesions. Here, we report a case of 60-year-old male patient with intramuscular ganglionic cyst, measuring 68×41×48 mm, arising in the extensor digitorum muscle of the left leg, which was diagnosed using MRI and treated using excision and biopsy.
Sociodemographic profile, clinical spectrum, and centers for disease control and prevention categorical evaluation of wound sepsis: Experience in a tertiary care hospital in India
Authors: Kadian Kiran , Singh Parul , Jain Shaveta , Dahiya Pushpa , Chauhan Meenakshi Barsaul , Goel Nidhi
Published: January 2025

Background: Over the last decade, the rate of cesarean sections has steadily increased owing to various reasons, and along with it the incidence of wound sepsis. Different risk factors identified are maternal age, socioeconomic status, educational status, antenatal visits, pregestational diabetes, obesity, recurrent pregnancy losses, duration of surgery, preterm rupture of membranes, etc. Hence, assessing infections and their management is an integral part of health care, as it helps develop strategies for prevention, better management of infection, reducing the hospital stay, and cost of healthcare.
Aims and Objectives: The aim of the study was to assess and note the variability of social and demographic profiles of patients undergoing cesarean sections and developing wound infection, along with its various presentations and categories.
Materials and Methods: A prospective observational study was conducted on patients who developed wound sepsis after undergoing cesarean section at a tertiary center in India.
Results: Among the patients enrolled, 35.83% were illiterate and 45.83% were educated up to the tenth standard. About 74% of patients were not registered during the antenatal period. Furthermore, the majority of patients were overweight and obese (74%) and were from lower socioeconomic strata. About 85% of the patients who developed wound infection had their surgery lasting for more than 60 minutes. About 87.50% developed a superficial category of infection, and 68.33% presented within the first 5 days of surgery. Patients with deep infected wounds had significantly bigger wounds and longer hospitalization.
Conclusion: Illiteracy and lower socioeconomic conditions predispose women to wound sepsis. A longer duration of surgery was associated with a higher risk of infection. Superficial wounds are the most common type of infection encountered. Deep and organ space categories of wound infection are associated with increased morbidity and longer hospitalization warranting aggressive management. Reducing the incidence of wound sepsis can help to reduce morbidity by identifying risk factors before pregnancy and supporting the implementation of preconception counseling centers and prenatal programs to educate and raise awareness among patients.
Morphometric analysis of pituitary gland using magnetic resonance imaging in Indian subjects
Authors: Krishna GK  , Harini Bopaiah  , Anil Kumar Sakalecha  , Lynn Joy
Published: January 2025

Background: Before the advent of magnetic resonance imaging (MRI), the radiological assessment of the hypothalamic-pituitary region relied on plain radiographs and computed tomography scans. However, contemporary medical practice now widely recognizes MRI as the preferred imaging modality for this purpose. The objective is to investigate variations in size and morphology of the pituitary gland associated with age and gender.
Aims and Objectives: (a) The aims of this study were as follows: To establish normative measurements of pituitary gland in South Indian population. (b) To evaluate the relationship between gender, weight, height, and body mass index in different patients using conventional MRI sequences.
Materials and Methods: This cross-sectional study, approved by the Institutional Review Board, included the enrolment of 140 normal individuals. The dimensions of the pituitary gland were assessed in 140 individuals exhibiting apparently normal pituitary gland function. The height and length of the pituitary gland were measured utilizing mid-sagittal T1-weighted images (T1-WI) obtained through MRI. The width of the pituitary gland was determined using coronal T1-WI, and the pituitary gland volume was subsequently calculated.
Results: This study comprised 98 females and 102 males. The anteroposterior dimension, height, and volume of the pituitary gland showed statistically significant correlations with age (P<0.05), while the transverse dimension did not show a significant correlation with age (P>0.05). The shape of the pituitary gland was found to have statistically significant correlations with age and gender. Conversely, the transverse diameter, height, and volume of the pituitary gland showed no significant correlations.
Conclusion: The findings underscore the importance of considering pituitary size, shape, and volume in the evaluation of neuroendocrine disorders.
Association between uric acid and cognitive function in maintenance hemodialysis patient
Authors: Avisek Maity  , Ajay Kumar Sowthiri
Published: January 2025

Background: Chronic kidney disease (CKD) is an independent risk factor for cognitive dysfunction. Hyperuricemia is prevalent in CKD patients and has been associated with cognitive dysfunction. Hyperuricemia has been associated with an increased risk for cerebral microvascular disease.
Aims and Objectives: The study aimed to evaluate the association between uric acid level and cognitive function in maintenance hemodialysis patients.
Materials and Methods: The study was conducted on 90 maintenance hemodialysis patients. Serum uric acid (sUA) level was measured in patients on maintenance hemodialysis and cognitive performance was assessed by the Standardized Mini-Mental State Examination score.
Results: There was a significant association between sUA level and cognitive function in hemodialysis patients. Patient with higher sUA levels was found to have poor cognitive function (P<0.05). There was a significant negative correlation between sUA and cognitive function which revealed an increase in sUA will decrease the cognitive function (P<0.05). In our study, there was a significant association between sUA and cognitive function in hemodialysis patients. Patients with hyperuricemia had poor cognitive function.
Conclusion: In our study, there was a significant association between sUA and cognitive function in hemodialysis patients. Patients with hyperuricemia had poor cognitive function.
Application of Six Sigma metrics for assessing the quality management of biochemical analytes in the clinical laboratory
Authors: Saurabh Singh  , Manisha Singh  , Devesh Sharma  , Ijen Bhattacharya  , Mamta Padhy  , Surabhi Puri  , Utkarsh Singh Tomar
Published: January 2025

Background: Quality control (QC) is an important part of clinical laboratory management which evaluates and maintains the performance of the clinical laboratory. Six Sigma is a continuous quality improvement process which is widely applied in the health care industry mainly in clinical laboratories.
Aims and Objectives: The study aimed to evaluate the performance of biochemical analytes in a clinical laboratory using Six Sigma metrics and to implement quality improvement interventions. Sigma value was analyzed using bias, coefficient of variation (CV), and total allowable error (TEa) for each analyte. The quality goal index ratio was calculated to identify specific types of errors to introduce targeted quality interventions.
Materials and Methods: This quasi-experimental study was carried out at the Government Institute of Medical Sciences, Greater Noida, Uttar Pradesh. Internal QC (IQC) and external QC data were collected during the study period and analyzed. The CV, Bias, and TEa were used to calculate the sigma (σ) values for 20 biochemical analytes.
Results: On retrospective data analysis, triglycerides-Level 1 (L1) and Level 2 (L2), and direct bilirubin-L2 showed a world-class performance (above 6σ) while 14 parameters were placed below average (<3σ) on sigma metrics. Prospective data analysis was performed following quality improvement intervention. Amylase, direct bilirubin, triglycerides and alanine transferase performed at world-class sigma metric for both the control levels (L1 and L2) whereas, Albumin and aspartate transferase showed above six sigma values for L2 control only. Five analytes out of 20 performed below average (<3σ) on sigma metrics, for which further continuous intervention will be carried out.
Conclusion: Six Sigma metrics is a continuous improvement and monitoring program that should be implemented to achieve world-class quality performance.
Antimicrobial susceptibility pattern and mupirocin resistance among methicillin-resistant Staphylococcus aureus isolated from skin and soft-tissue infection patients attending a tertiary care hospital in North India
Authors: Bajarangi Lal Chaudhary  , Sanjeev Sahai
Published: January 2025

Background: Antimicrobial susceptibility among bacterial isolates varies from center to center. Mupirocin is a topical antibacterial antibiotic used to treat wound infections caused by methicillin-resistant Staphylococcus aureus (MRSA).
Aim and Objectives: This study was conducted to know the prevalence of high and low levels of mupirocin resistance along with antimicrobial susceptibility in MRSA isolates from skin and soft-tissue infection in patients admitted to a tertiary care hospital in North India.
Materials and Methods: A total of 97 non-repetitive isolates of MRSA from various pus samples over a period of 1 year were included in this study. These strains were identified as per standard laboratory protocols given by the Clinical Laboratory Standards Institute. High- and low-level mupirocin resistance of the isolates was tested by using mupirocin discs of 200 μg and 5 μg, respectively. Mupirocin strips of 256 μg and 512 μg were used for the E-test to detect low-level and high-level mupirocin resistance, respectively. The isolates were reported as sensitive to mupirocin, with minimum inhibitory concentrations of <4 mg/L.
Results: Overall, 9.27% of mupirocin resistance was found, of which 2.06% of isolates were high-level resistant to mupirocin, while 7.21% had low-level resistance. All MRSA strains were susceptible to vancomycin, followed by linezolid (94.84%), teicoplanin (91.75%), and fusidic acid (88.65%).
Conclusion: Regular monitoring, good infection control practices, and proper awareness about utilizing mupirocin therapeutically and prophylactically may help prevent the emergence of mupirocin resistance in health-care facilities.
JN.1: The new COVID-19 variant of concern?
Authors: Ruby Dhar  , Hiya Aidasani  , Om Saswat Sahoo  , Arun Kumar  , Subhradip Karmakar
Published: January 2025

Emergence of new variants of COVID-19 is nothing new. Different variants evolved with additional mutations of the virus as part of the viral replication cycle have different infectious properties. JN.1 is the latest COVID-19 variant that seems to circulate the globe contributing to many infections and hospitalizations labeling it a variant of interest by the WHO. The scientific community has yet to understand its full lethal potential if any. In this mini-review, we summarized the facts known so far about this variant and its possible consequences if any for humanity.
A case of ostium secundum atrial septal defect for major decompressive spine surgery – covering the paths still left untreaded
Authors: Nidhi Sultania  , Priyanka Bansal  , Kunal Bansal
Published: January 2025

Atrial septal defect (ASD) accounts for 35% of all congenital heart diseases in adults. Patients usually present in their twenties or thirties owing to gradually progressive right ventricular remodeling because of left to right shunt, right-sided heart failure, and pulmonary hypertension. In this case report, we present the management of young female patient with ASD posted for D5 spine decompression and fixation. Patients with congenital heart disease for spine surgery present with unique set of challenges for anesthesiologists. Well-prepared anesthesia plan is essential to prevent increase in shunt fraction, shunt reversal, hypoxia, hypercapnia, acidosis, and hypothermia along with careful addressal of positioning issues to ensure smooth recovery of patient.
Torsion of wandering spleen presenting as acute abdomen: A case report
Authors: Surya Prakash  , Pankaj Saunakiya  , Gouthaman S  , Abhishek Kumar Yadav  , Sandeep Kumawat
Published: January 2025

Wandering spleen is a very rare condition characterized by the absence or weakness of one or more ligaments holding the spleen in its normal position. “Acquired” wandering spleen may occur during adulthood due to injuries or other underlying conditions that may weaken the ligaments that hold the spleen in its normal position. Torsion of a wandering spleen is an unusual cause of an acute abdomen and is rarely diagnosed preoperatively. Associated torsion of the distal pancreas is even more uncommon. We report a patient with torsion of a wandering spleen and distal pancreas presenting as acute abdomen with lower abdominal lump who was further diagnosed and managed.
Comparison of hemodynamic and analgesic effects of interscalene block with bupivacaine versus bupivacaine-dexmedetomidine combination for shoulder arthroscopy under general anesthesia
Authors: Jahangir Mullick  , Amit Kumar Ray  , Soma Chakraborty  , Bidyut Bikas Gharami
Published: January 2025

Background: The interscalene block in shoulder arthroscopy is a well-established procedure. Many drugs have been used as adjuvants to local anesthetics to increase the quality of block in regional anesthesia, with variable results.
Aims and Objectives: The present study was designed to evaluate the effect of dexmedetomidine as an adjuvant to bupivacaine during interscalene block in terms of intraoperative hemodynamic changes and postoperative analgesia.
Materials and Methods: Thirty patients, aged 20–55 years of either sex, American Society of Anesthesiologists physical status I-II, scheduled for shoulder arthroscopic surgery for <2 h, were allocated into two equal groups to receive inj. bupivacaine (0.25%) with inj. dexmedetomidine 1 μg/kg (Group BD, n=15) or inj. bupivacaine (0.25%) with 1 mL normal saline (Group BS, n=15), total volume 20 mL in each case. After settlement of the interscalene block, both groups received general anesthesia as per standard protocol. Hemodynamic parameters (heart rate [HR] and systolic blood pressure [SBP]) were assessed in the intraoperative period, and postoperative pain was assessed using a visual analog scale score in the postoperative period at stipulated time points.
Results: The mean values of HR and SBP were considerably low at all observed time points in the intraoperative period (i.e., at 10 min, 30 min, 60 min, 90 min, and120 min), in comparison with the saline group (P<0.0001). VAS scores between the two groups were considerably lower only at 8, 12, and 18 h in patients receiving dexmedetomidine (P<0.001).
Conclusion: Dexmedetomidine as an adjuvant with bupivacaine can achieve a better hemodynamic profile (lower HR and SBP) in the intraoperative period. Also, the use of dexmedetomidine provides better postoperative analgesia profiles in the later part of the postoperative period (8–18 h), and the effect usually wanes by 24 h.
Comparison of different methods of local anesthesia for platelet rich plasma injections to scalp in patients with hair loss - A prospective study
Authors: Vishnu Sundar Ramachandran  , Singaravelu Viswanathan  , Krithiga Sivakumar
Published: January 2025

Background: Platelet-rich plasma injection (PRP) for hair loss is a widely accepted treatment modality at present. The most common problem with PRP is the pain that is associated with the procedure. The type of anesthesia is decided mostly based on preference rather than protocol.
Aims and Objectives: The current study was undertaken to establish a standardized anesthetic protocol for PRP based on the response of the patients undergoing the treatment plan.
Materials and Methods: The study included 60 patients who underwent four sittings of PRP at 1-month intervals for hair loss treatment. The modality of anesthesia was different during each of the sessions - topical anesthesia, vibration anesthesia, nerve block, and ring block. The order of anesthetic modality was different in each patient, to avoid bias. Responses by the patients for the following questions related to anesthetic pain during the procedure was recorded and analyzed based on the type of anesthetic procedure adopted.
Results: Vibration anesthesia had the highest mean intra procedure numerical pain scale value. Nerve block was the least acceptable modality with maximal problems including the pain of the local anesthetic injection and the unsightly visible bulge in the supra orbital region. Post procedural pain was highest for vibration anesthesia and least for ring block. Highest acceptance was seen with the ring block technique.
Conclusion: This is a preliminary study aimed at standardizing the anesthetic protocol for PRP. This modality of treatment involves multiple sittings with long total duration. Improving patient comfort with adequate anesthesia will improve compliance to a great extent.