bluuebunny/crossref_metadata_2025 huggingface dataset:
Effectiveness of video assisted teaching program on knowledge regarding good touch and bad touch among school age children in selected schools of Jodhpur
Authors: Khan Rubi , Mohan Remiya , Sharma Mukesh Chandra
Published: July 2021

Background: The purpose of research was to provide education for every school child about good touch and bad touch so that the child can protect himself in this threatening condition.Methods: A quantitative approach, pre-experimental one group pre-test post-test only design was adopted to assess the effectiveness of video assisted teaching programs on good touch and bad touch amongst 150 school children, who fulfilled the inclusion criteria at selected government schools of Jodhpur. Non-probability convenient sampling was used to select the samples. Good touch bad touch knowledge was assessed using a structured questionnaire. Data analysis was performed in SPSS version 16 using descriptive statistics and Chi square as well as paired t test.Results: The study revealed a statistically significant difference between mean pre-test score (16.09) and mean post-test (20.56) score. In pre-test more than one third (39.3%) of children had average knowledge and 8.6% children had poor knowledge, whereas in post-test more than half (54.6%) of children had excellent knowledge and (42%) children had good knowledge. Study further revealed the significant association of religion, total number of siblings and marital disharmony with the pre-test knowledge score.Conclusions: From this study finding, concluded that a video assisted teaching program pertaining to good touch and bad touch is an effective program in improving the knowledge and awareness amongst the children, which has been depicted in the result, that there was a marked increase in post-test level of knowledge.
Siblings with Imperforate anus and aplastic nasal alae: Johanson-Blizzard syndrome
Authors: Nagarasaraiah Ashwini Harohalli , Gubbari Chinthan S. , Govindarajan Varun , Reddy Chikkanarasa
Published: July 2021

Johanson-Blizzard syndrome is a rare genetic entity reported in medical literature resulting from mutations in UBR1 gene, affecting pancreas, craniofacial and urogenital development, causing significant morbidity and mortality. We report a neonate presenting with anorectal malformation requiring surgical intervention at birth, with similar surgeries being performed in two elder siblings. Surviving sibling of the proband neonate also has similar dysmorphic features of absent ala nasi, aplasia cutis of scalp along with pancreatic insufficiency, profound sensorineural hearing loss, pheno-type corresponding to Johanson-Blizzard syndrome. Syndromic diagnosis helps in screening for associated potential issues, which can intervened at early stages.
The relation between mean platelet volume and platelet distribution width to COVID-19 severity
Authors: Nugraha I. Kadek Aditya , Atmaja Kadek Surya , Suryana Ketut , Putra Wayan Wahyu Semara
Published: July 2021

Background: Wide spectrum of clinical manifestation and severity of COVID-19 led to further studies to find a simple biomarker used to predict the severity of COVID-19. We investigated the role of mean platelet volume (MPV) and platelet distribution width (PDW), widely available parameters, as predictor of COVID-19 severity.Methods: We conducted a single center analytic observational study to evaluate the relationship between MPV and PDW values and COVID-19 severities. A total of 123 subjects of COVID-19 within October to December 2020 included in the analysis.Results: Analysis showed a statistically significant difference in MPV, PDW, and D-dimer between COVID-19 severities (p<0.001, p=0.002, and p<0.001). Correlation coefficient between MPV, PDW, and D-dimer with COVID-19 severity were 0.28 (p=0.002); 0.22 (p<0.001), and 0.81 (p<0.001), but there’s no correlation between MPV (p=0.176) and PDW (p=0.383) with D-dimer. The AUC value of the ROC curve of MPV, PDW and D-dimer in predicting severity was 79% (p=0.001, 95% CI: 0.696-0.885), 72.5% (p<0.001, 95% CI: 0.598-0.852), and 97% (p<0.001, 95% CI: 0.937-1.00).Conclusions: This study found a relationship between MPV and PDW values on the severity of COVID-19. There’s no relationship of MPV and PDW to D-dimer concentration.
Assessment of knowledge and prevalence of drugs and substance abuse among the students of a selected tertiary health institution in Kano, Nigeria
Authors: Musa Abuhuraira Ado , Abdullahi Yusuf Muhammad , Salihu Muhammad Nuhu , Lawal Mamman Muhammad , Joseph Solomon Arigwe , Umar Maryam Dahiru , Muhammad Faisal
Published: July 2021

Background: Drugs and substance abuse is one of the commonest emerging public health problems among both adults and adolescents in developing countries. This study aimed to assess the level of knowledge and prevalence of drugs and substance abuse among the students of a selected tertiary health institution in Kano, Nigeria.Methods: A multistage sampling technique was used during selection of the participants and the study was conducted for a period of 4 months (July to November, 2019). A total of 151 students from school of health technology Kano, Nigeria were recruited and the data was collected using a self-administered semi-structured questionnaire. Data was analyzed by the use of statistical software (SPSS version 20.0) and the results were presented in the form of figures and tables with frequencies and percentage. In addition, a statistical test of significance (x2 test) was applied to determine the significant associations between variables, p≤0.05 was considered statistically significant.Results: The mean age of study participants was 27.2±6.3 years and majority of them (64.2%) were between 20-25 years. More than nine-tenths (94.0%) of the respondents were Hausa/Fulani, and 32.5% of the respondents were SCHEW students. Little above half (53.6%) of the respondents were earning less than 11000 naira per month and 62.3% of the respondents sourced the information regarding drugs and substance abuse from their friends. All the respondents have seen cigarettes before and 57.6% have seen inhalants (such as glue, petrol etc). Regarding the reason for substance/drug abuse; about 68.9% stated that it’s an addiction and based to the factors enhancing drugs and substance abuse; 72.7% mentioned that it was due to peer pressure, and 72.2% mentioned unemployment. Based on societal factors that promotes drugs and substance abuse; more than three-fifths (64.9%) mentioned that it was reluctant attitude of people and 20.5% mentioned it was some cultural factors.Conclusions: The prevalence of drug and substance abuse was 18.5%. Nevertheless more than three-fifths of them had good level of knowledge regarding drug and substance abuse. The ethnicity of the respondents was found significantly associated with level of knowledge regarding drug and substance abuse. There is need for more focused attention by parents, teachers, government and general public on the problem of drug and substance use.
Post-operative day 2 versus post-operative day 4 foley catheter removal after trans urethral resection of prostate
Authors: Pogula Vedamurthy Reddy , Galeti Ershad Hussain , Bharali Mriganka Deuri , Kanchi Bhargava Reddy
Published: July 2021

Background: Usually after TURP surgery for BPH, a three-way foleys catheter is placed transurethrally and removed post-operative day 4. This study done at our institute is to help decide the interval for removal of foley catheter following TURP, which is most beneficial to the patients. The objective is to know whether the POD-2 removal of the catheter in post TURP patients will be beneficial compared to the traditional POD-4 removal.Methods: This is a prospective study on 100 patients with BPH who underwent TURP. Patients were assigned to POD-2 and POD-4 groups. A standard TURP was performed on all the patients. After removing the catheter on POD-2 and POD-4, the patients were observed, and outcomes were carefully recorded in the two groups.Results: The highest incidence of the disease was in the age group of 60 - 75 years (70%). The majority of patients had nocturia present in 80 out of 100 patients (80%).55% of patients had grade III prostatomegaly. Most of the patients, 55 (55%), had prostate volume between 30 and 50 grams. No statistical significance noted in terms of retention of urine, post-void residual urine. The average duration of hospital stay post-surgery for group I was 3.7 days, and in group II was 5.1 days which is statistically significant.Conclusions: Our study shows that early catheter removal after two days following Transurethral Resection of Prostate (TURP) is safe, cost-effective to the patient, reduces the post-operative hospital stay.
A gender wise correlation analysis between glycated hemoglobin level and estimated glomerular filtration rate among type 2 diabetes patients
Authors: Leena Chalissery Ouseph , Ajith Thekkuttuparambil Ananthanarayanan , Vijayasimha Mulavagili , Sah Ashok Kumar
Published: July 2021

Background: Studies found inconsistent relationship between glycated hemoglobin (HbA1C) and estimated glomerular filtration rate (eGFR) in diabetes. Hence, population based studies are warranted. This study was aimed to find out the prevalence of good glycemic control and correlation of HbA1c level with eGFR in male and female type 2 diabetes patients. Methods: A cross sectional study was designed among type 2 diabetes patients. Medical records of patients’ in the inclusion criteria were abstracted for demographic characteristics, HbA1c and serum creatinine level. Patients were grouped into male and female and further sub grouped as with or without good glycemic control (HbA1c ≤ 7%). Data were statistically analyzed.Results: A total of 465 diabetes patients (186 males and 279 females) were included. Among the total, more female patients were in good glycemic (p=0.0008) control.  Gender wise comparison showed that HbA1c level was statistically significant between male and female patients in age groups below 60 years (p<0.05). HbA1c level, at >7%, showed an inverse correlation with eGFR in both male (r=- 0.3208, p=0.0008) and female patients (r =-0.3680, p<0.0001). For every 1% rise in HbA1c, eGFR declined by 10 ml/min/1.73 m2 in males and 13 ml/min/1.73 m2 in females.Conclusions: More female patients were in good glycemic control. HbA1c level above 7% showed an inverse correlation with eGFR in both male and female patients. For every 1% rise in HbA1c, the eGFR declined by 10 ml/min/1.73 m2 in male and 13 ml/min/1.73 m2 in female patients.
A comparison of high thoracic epidural anaesthesia versus conventional intravenous opioids in pediatric patients undergoing corrective open heart surgery for ventricular septal defect
Authors: Singh Kshetrimayum Sandeep Kumar , Sharma Vipul K. , Shouche Sachin , Sasidharan Shibu , Dhillon Harpreet
Published: July 2021

Background: We compared high thoracic epidural anaesthesia with a combination of morphine and bupivacaine versus IV fentanyl as an alternative for perioperative pain management.Methods: Group-E: Injection Morphine 75-100 mcg/kg and Injection 0.25 % Bupivacaine 0.5 ml/kg was given via epidural catheter at insertion, Injection 0.25% Bupivacaine 0.5 ml/kg just before skin incision, and  continuous infusion of Injection 0.125% Bupivacaine at 0.2 ml/kg/hr intra-operatively. Post-operative 0.1 ml/kg/hr infusion. Group F- intravenous fentanyl 2-3 mcg/Kg IV bolus given just before skin incision, followed by 1-2 mcg/Kg/hr IV fentanyl started after weaning from cardiopulmonary bypass.Results: The mean ScvO2 was comparable between the two groups during induction period but became higher in group E during bypass and post bypass period intraoperatively, and the difference in rise in ScvO2 is statistically significant with a p<0.05. The mean rSo2- C was comparable between the two groups in the first postoperative hour but group F shows higher rSo2-C postoperatively which was statistically significant. The postoperative pain was significantly lower in group E in the postoperative period (except for 4,5,6 and 40 and 48th hour).Conclusions: HTEA to paediatric patients prior to sternotomy for cardiac surgeries resulted in a much better control of haemodynamic parameters. Produces better central venous and regional tissue oxygenation during bypass and post bypass intraoperatively as compared to the patients that received only intravenous fentanyl. There was lower amount of postoperative bleeding in the HTEA group with significant reduction in requirement of post-operative ventilation and time to extubation after surgery, better post-operative pain control and overall outcome.
Invasive pulmonary and sino-orbital mucor mycosis in patient with SARS-Cov-2 infection with diabetic ketoacidosis
Authors: Singla Neeraj , Agrawal Suraj , Bhankhur Dimpi
Published: July 2021

Patients with Severe acute respiratory syndrome coronavirus-2 (SARS-Cov-2) are susceptible for developing fungal infection due to uncontrolled diabetes or immunosuppression. A 46 years male presented with diabetic ketoacidosis, respiratory failure with peri orbital blackish discoloration with SARS-Cov-2 positive report. Computed tomography (CT) chest was suggestive of perihilar ground glass opacity and multiple thick-walled cavities. Left nasal cavity scrapings revealed hyaline aseptate hyphae and growth of Rhizopus arrhizus. Patient was initially managed conservatively with liposomal amphotericin B but later underwent orbital exenteration and finally succumbed. We want to emphasize higher mortality and aggressive management of mucor mycosis when it occurs with SARS-Cov-2 as a concurrent illness.
Hypoglycemia due to insulin autoimmune syndrome (Hirata’s disease): a rare cause of hypoglycaemia
Authors: Patel Het V. , Kumar Sunil , Moradiya Kalpesh , Shah Vidhi
Published: July 2021

Although the most common cause of recurrent hypoglycaemia is diabetes mellitus as patient is on antidiabetic medications which can be prevented by modification of antidiabetic doses, nutrition therapy and lifestyle modifications. Some endogenous hyperinsulinemic conditions like insulinoma, functional beta cell disorders and insulin autoimmune syndromes, hormonal deficiencies can cause serious and sometimes life threatening hypoglycaemia. So further laboratory evaluation like plasma/serum glucose levels, c-peptide levels, insulin levels, insulin antibodies and imaging studies are needed to evaluate unexplained hypoglycaemia. Here we report a case of insulin autoimmune syndrome in a 67 year old Indian male who had presented to us with multiple episodes of spontaneous hypoglycaemia. On further workup, the patient was found to have endogenous hyperinsulinemic hypoglycemia. As the patient’s abdominal imaging revealed no apparent cause of EHH, on further evaluation he came positive for insulin antibodies. Patient was diagnosed as IAS and he was given frequent small meals and complex carbohydrate diet and he had improved symptomatically. The incidence of IAS is most common in Japan and very few cases have been reported from India, so it should be kept in differential diagnosis of recurrent hypoglycaemia.
Ginkgo leaf sign on X-ray chest due to subcutaneous emphysema in a COVID-19 patient
Authors: Behera Ashish , H. Mohan Kumar , Bakshi Rohit , Sharma Arihant
Published: July 2021

Subcutaneous emphysema (SE) is usually encountered in cases of structural lung diseases and secondary to direct trauma or iatrogenic procedures for airway access. It is mostly associated with pneumothorax. The diagnosis is made clinically by palpation of the affected area and radiology. Here we presented a case of COVID-19 pneumonia presenting with extensive subcutaneous emphysema resulting in airway compression which was a very rare manifestation of COVID-19 infection. The COVID-19 infection led to extensive alveolar damage to the lungs and the chronic cough which may have led to this complication due to sudden change of pressure differences in the chest wall cavity. The limitation of using of personal protective equipments hindered the diagnosis of this condition as auscultation and the palpatory feelings were greatly hindered. The chest X-ray shows air in subcutaneous space and the prominence of the fibres of bilateral pectoralis muscles which gives an impression of the venous system of a Ginkgo leaf, so named as Ginkgo leaf sign.
Thyrotoxic periodic paralysis with normokalemia: a rare case report
Authors: Kulkarni Pranav Ravi , M. Jagadeesan , I. Mariraj , S. Prasanna Karthik
Published: July 2021

Thyrotoxic periodic paralysis (TPP) is a rare etiology for muscle paralysis. It is frequently seen in Asian men. Apart from paralysis, most of them are asymptomatic and are devoid of other clinical features of hyperthyroidism. Due to the rarity of this condition, it is often missed and hence fatal. The metabolic derangement seen in TPP is hypokalemia and is thought to be the pathogenesis of the muscle paralysis. Although in rare clinical encounters, patients with TPP may present with normokalemia. The disorder usually presents in the 3rd decade. The cause for mortality in patients with TPP may be due to respiratory muscle paralysis leading to compromise of the respiratory function or refractory arrhythmias due to hypokalemia. Here we report a rare case of TPP with normokalemia.
Fulminant hepatic failure in pregnancy: challenges, management strategies, prognosis and outcomes
Authors: Parasher Anant , Mohan Vandana
Published: July 2021

Fulminant hepatic failure is defined as a sudden, severe impairment of hepatic function leading to an encephalopathy, which occurs within eight weeks of appearance of first symptoms in the absence of pre-existing liver disease. The spectrum of liver disease in pregnancy may range from mild asymptomatic transaminitis to fatal and irreversible deterioration in liver function leading to significant morbidity and even mortality. Hepatic dysfunction in pregnancy may be categorized into Pre-eclampsia-associated liver diseases such as pre-eclampsia/eclampsia, the HELLP syndrome and Acute fatty liver of pregnancy (AFLP), and other causes of hepatic dysfunction namely Hyperemesis gravidarum (HG) and Intrahepatic cholestasis of pregnancy (IHCP). For this review, a search was conducted for published articles, case reports and clinical trials in MEDLINE/Pubmed from 1970 to 2020 with the keyword’s fulminant hepatic failure, acute liver failure in pregnancy, pre-eclampsia, HELLP and AFLP. We concluded that fulminant hepatic failure is one of the most dreaded complications in pregnancy in obstetrical units worldwide. Mandatory screening for etiology, early diagnosis and initiation of supportive management as soon as possible are absolutely essential to ensure better maternal and fetal outcomes. Effective communication with the obstetrician regarding timely delivery/termination of pregnancy ensures a favourable prognosis in the majority of cases. Liver transplant is a definitive life-saving option for cases of severe fulminant hepatic failure in pregnancy, and management has to be suited to each patient individually, keeping in mind the well-being of both the mother, and the child.
Prevalence of metabolic syndrome in type 2 diabetic patients
Authors: Uprety Tina , Kunwar Saroj , Rai Ashim , Khanal Avaya , Thapa Shraddha , Gurung Soumya Harsha , Shrestha Sanjita , Karmacharya Prakirti , Poudel Govinda Akela
Published: July 2021

Background: Metabolic syndrome (MetS) and diabetes mellitus concurrently potentiates a number of risk factors, significantly higher prevalence of cardiovascular diseases. Numerous risk factors associated with diabetes gets intensified by the presence of metabolic syndrome. Diabetes and metabolic syndrome together can increase the risk of cardiovascular disease by 2 to 4 folds. The main objective of this study was to determine the prevalence of MetS in type 2 diabetic mellitus (T2DM) patients. Components of metabolic syndrome were measured and compared to determine the prevalence.

Methods: Hospital based cross-sectional study was conducted from September 2019 to December 2019 at star hospital and modern technical college, Sanepa, Nepal. A total number of 353 patients with T2DM visiting star hospital were included in the study.

Results: Among 353 participants, MetS was diagnosed in 242 (68.5%) participants using NCEP-ATP III criteria. The prevalence of MetS was 68.5% among which male were 123 (76.3%) and female were 119 (61.9%). MetS was found to be highest in age group of 50-59 years with 34.2% (83) participants. Dyslipidemia with raised TG (triglyceride) 71.4% and reduced HDL 76% was found to be most prevalent component in our study followed by hypertension 73.1%.

Conclusions: 68.5% prevalence of MetS in T2DM with 76.3% male and 61.9% female according to NCEP-ATP III was found with anthropometric indices significantly higher in the male population compared to female population.
Knowledge and preparedness of community pharmacists in the fight against COVID-19 in Zambia
Authors: Hangoma Jimmy Mapenzi , Mudenda Steward , Mwenechanya Mpande Mukumbwa , Kalungia Aubrey Chichoni
Published: July 2021

Background: The coronavirus disease (COVID-19) pandemic has severely strained healthcare systems globally. Community pharmacists remain vital health professionals with unique roles in responding to symptoms, supplying medicines and providing health promotion in the communities where they serve. The purpose of this study was to assess knowledge and preparedness of community pharmacists in the fight against COVID-19 in Zambia.

Methods: This descriptive cross-sectional survey was conducted among 300 registered community pharmacists in Zambia from April to May 2020. A self-administered online questionnaire was used to collect the data. Descriptive statistics were used to analyse the data using the statistical package for social sciences version 23. All statistical tests were set at 95% confidence level (p<0.05).

Results: From a total of 393 community pharmacists, 300 participated in the study indicating a response rate of 76.3%. 97% of the pharmacists knew the common signs and symptoms of COVID-19, 83% knew the national guidelines for screening criteria and 93% were aware that a suspected case of COVID-19 presenting to the community pharmacy needed to be alerted to the national response team. Only 59% knew they needed to self-isolate and self-report should they experience symptoms of COVID-19. 85% stated that personal protective equipment was inadequate in the pharmacies they operated from. 60% of the pharmacists were prepared to participate in the frontline fight against COVID-19.

Conclusions: Community pharmacists in Zambia are knowledgeable about COVID-19 signs and symptoms including the technical guidelines on the screening and detection of suspected cases. Community pharmacists are prepared to participate in the frontline fight against the COVID-19 pandemic in Zambia.
Music listening practices of college-going students and their impact on hearing
Authors: H. Gayathri , Paul Christina Mary P.
Published: July 2021

Background: A billion youngsters are at risk of recreational noise-induced hearing loss. Motivated by WHO’s campaign ‘Make listening safe’, the objective of this study was to estimate the prevalence of the habit of listening to music at high volumes using Personal Listening Devices (PLDs) among college students and to analyze their audiometric findings.

Methods: This cross-sectional study was performed between December 2019 and May 2020 on college-going students with a habit of listening to music using PLDs. PTA was performed on the eligible study subjects. A modified LHQ was given to the selected candidates to answer.  

Results: The study population comprised 62 boys (24.5%) and 191 girls (75.5%) of the age of 17-24 years. 77.1% of the participants listened to music through PLD, at a scale of >5 on 10 (median PLD volume-7). 26.1% of students listened to music for more than 14 hours a week using their headphones or earphones. Fifteen students (5.93%) had evidence of a 4 kHz dip on PTA out of which 9 patients (3.56%) had bilateral and 6 patients (2.37%) had unilateral involvement.

Conclusions: Though many students had some awareness regarding safe volume levels while listening to music, not many were aware of daily sound allowance (DSA). Health education to the target population along with the addition of an in-built app in all PLDs for monitoring device volume and DSA may reduce the impact of music on hearing.
Post-operative hypocalcemia in patients undergoing thyroid surgeries in tertiary care hospital: an observational study
Authors: Maqbool Tabish , Showkat Showkat Ahmad , Mehta Kulvinder Singh
Published: July 2021

Background: Post-operative hypocalcaemia is one of the most common complications of thyroid and parathyroid surgery. Temporary hypocalcaemia has been reported to occur in 1.6-50% of the patients undergoing bilateral thyroid resection. Permanent hypoparathyroidism results in 0-13% of patients after bilateral thyroid surgery.

Method: We have analyzed the data of 34 patients undergoing total thyroid surgery (with or without neck dissection) and completion thyroidectomy at the department of ENT and HNS, SMHS hospital over a period of 1.5 years between May 2019 to November 2020.

Results: Hypocalcemia was found in a total of 15 patients out of 34 patients in the post-op period. Among the total patients who developed hypocalcemia 5 (14.7%) were males and 10 (29.4%) were females. Among the patients who developed post-op hypocalcemia 14 patients developed transient hypocalcemia (p>0.01) which is not statistically significant and 1 patient developed permanent hypocalcemia (p>0.01) which also has no statistical significance.

Conclusions: The study suggests that female gender is a strong risk factor for developing post-operative hypocalcemia, other factors that play a role include difference in serum calcium levels in the perioperative period and type of surgery.
Round window versus conventional bony cochleostomy technique in pediatric cochlear implantation; A Randomized controlled double blinded trial.
Authors: Shishodia Shama , Saurav Dipu
Published: July 2021

Background: Objective of the study was to investigate the outcomes of cochlear implantation when done via two different techniques namely, the round window or the bony cochleostomy.

Methods: A single-center, double-blinded randomized controlled trial including forty prelingual, bilateral severe to profoundly deaf children less than six years from the year 2014 to 2016 in a tertiary referral center in India were randomly allocated to round window and bony cochleostomy group. Our primary outcome measures were intraoperative neural response telemetry levels, behavioral threshold (t) and comfortable (c) loudness levels. The secondary subjective outcomes were measured via the category of auditory performance (CAP) and the meaningful auditory integration scale (MAIS) score. The cases were followed up for 9 months.

Results: Intra-operative, electrically evoked compound action potentials (ECAP) showed comparable mean thresholds for both the techniques except intermediate electrodes (p~0.04) showed lower values for the round window. Similarly, a lower threshold (p~0.03) and comfortable mean current levels (p~0.03) were noticed for the round window group at 6 months post-implantation. Secondary speech perception outcome scores measured via category of auditory performance (CAP) and MAIS score were comparable. 

Conclusions: The round window insertion technique has physiological benefit as compared to the bony cochleostomy as evidenced by better stimulation levels in the intermediate electrodes and lower mean threshold and comfortable levels in the round window with more beneficial peri-modiolar position of electrode arrays. However, comparable speech perception outcomes revealed no clinical benefit in the cochlear implant performance depending on the technique of electrode insertion. 
A study on correlation between clinical prognostic markers glycated hemoglobin, erythrocyte sedimentation rate and C-reactive protein levels and the stage of disease in malignant otitis externa
Authors: Antony Subin , Ross Anita , Satish Deepthi
Published: July 2021

Background: Objectives of the study were to establish a clinical correlation between the stages of MOE and biochemical markers namely glycated Hb (HbA1c), C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) levels, to identify improvement in clinical symptomology in MOE following treatment and to correlate with the duration of diabetes mellitus with treatment outcome.

Methods: Patients with diabetes mellitus, otalgia and ear discharge presenting to ENT OPD were subjected to detailed history and clinical examination. Otoscopic examination was done. Pus from the EAC was taken for culture and sensitivity. Baseline glycated Hb, ESR and CRP levels and HRCT temporal bone in axial and coronal planes was done. According to clinical findings and CT findings the patients were staged using chandlers staging. Patients were followed up after 1st and 2nd month and otoscopic examination with blood tests was repeated and staged accordingly

Results: Fall in the levels of glycated HbA1c serves as a good prognostic indicator of the disease. Duration of diabetes has no significant impact on the disease prognosis. Most common etiologic agent is Pseudomonas aeruginosa. In spite of improvement in clinical features and inflammatory parameters there was no improvement in clinical staging with treatment. There was a significant fall in ESR and CRP values after treatment for 2 months with antibiotics and analgesics.

Conclusions: The study highlights the need to control infection with medical line of treatment which can be monitored by ESR, CRP and glycated HbA1c and that the role for surgical management is limited for stage 1, 2 and 3.
Impact of hydration on vocal loading using phonetogram measures
Authors: Ghosh Sujan , Chatterjee Indranil , Kundu Piyali , Pani Susmi , Kumar Suman , Mandal Joyanta Chandra
Published: July 2021

Background: Vocal loading is a phenomenon that affects the vocal folds and voice parameters. Prolonged vocal loading may cause vocal fatigue. Hydration is one of the easiest precautions to reduce the effect of vocal loading. Voice range profile is an analysis of a participant’s vocal intensity and fundamental frequency ranges. Speech range profile is a graphical display of frequency intensity interactions occurring during functional speech activity. Phonetogram software can analyse VRP and SRP.

Methods: Total sixty normophonic participants (thirty male and thirty female) were included in this study. Phonetogram, version 4.40 by Tiger DRS, software used to measure the voice range profile and speech range profile. For VRP, participants were asked to produce vowel /a/ and a passage reading task was given for SRP measurement.

Results: All sample recording were done at pre vocal loading task, VLT and after hydration. Parameter that were used to measure the effects were Fo-range, semitone, max-F, min-F, SPL range, max-I, min-I, area (dB). Result showed that after VLT all other parameters like Fo-range, semitone, max-F, min-F, SPL range, max-I, min-I, area (dB) in VRP and SRP were reduced except min-F VRP in male, min-I VRP and min-I SRP in both male and female participants. After hydration all other parameters were improved except max-F VRP and min-F VRP in female, max-I VRP, min-F VRP and area VRP.

Conclusions: This study concluded that vocal loading has negative impact on vocal fold tissue and mass. 
Microbiological pattern in patients with complicated chronic suppurative otitis media requiring surgical intervention
Authors: Hemalatha P. , Shankar R.
Published: July 2021

Background: Pseudomonas aeruginosa, Staphylococcus aureus, E. coli, Proteus mirabilis, Klebsiella spp, Streptococcus pyogenes, Candida spp and Aspergillus spp were the common pathogens detected in the ear swab of CSOM patients. The aim was to study the microbiological pattern among patients with complicated chronic suppurative otitis media (CSOM) requiring surgical intervention for CSOM and to assess any particular pathogen influences the complications in CSOM.

Methods: A prospective longitudinal study was conducted in the department of ENT of a government tertiary care institute in Tamil Nadu for a period of one year. A total of 67 patients requiring surgical intervention for CSOM were taken as our study sample. The microbiological testing was done for each patient by taking two swabs from the ear discharge. Based on their indication all the patients had underwent either tympanoplasty, myringoplasty or mastoidectomy.

Results: P. aeruginosa was found to be the most common microorganism detected in our patients followed by S. aureus and CONS. S. aureus and CONS showed a significant association with atico-antral type of CSOM. Majority of the patients reported with no growth had tubotympanic type of CSOM. in majority of the patients who had reported with no growth their ET (eustachian tube) function was found to be normal whereas patients reported with microorganisms such as Pseudomonas, Staphylococcus and CONS most of them had partial dysfunction of ET or complete absence of ET function.

Conclusions: Swab culture for CSOM patients to be done at the early stage and treating them appropriately would prevent further complications due to the disease.
Isolated 6th cranial nerve palsy: a rare manifestation of tuberculosis
Authors: Kantharia Shehnaz , Kantharia Rajesh A. , Reddy P. Pradeepkran
Published: July 2021

Tuberculosis (TB) is a contagious infection that is usually caused by Mycobacterium tuberculosis bacteria. It usually affects the lungs and also spreads to the brain and spine. In the central nervous system, the neurological manifestations are numerous and varied and usually occur in two major forms, tuberculous meningitis and tuberculoma. Tuberculoma are well defined, granulomatous, space occupying lesions, which can occur anywhere in the central nervous system. Usually, brainstem tuberculoma can cause sixth and seventh cranial nerve affections along with motor and sensory symptoms, which are usually unilateral. Isolated abducens nerve palsy could be attributed to lesions of the nerve along their extra axial course and cause diplopia. Here we are presenting a case report of an 18-year-old boy with isolated sixth nerve palsy due to tuberculosis. The diagnosis of tuberculosis was achieved using interventional radiology for the purpose of biopsy. Using an image guided technique, we could avoid an open surgical procedure. 
A rare lesion of the wanderer’s nerve with an unusual postoperative complication: vagal nerve schwanomma
Authors: B. Jagnnatha , Dasappa Pandu , Hanumaiah Suhasini , Sheeja Arunima
Published: July 2021

Vagal nerve schwannomas are rare parapharyngeal tumours which was first described by Figi in 1933. Hoarseness is the most common symptom. Occasionally, a paroxysmal cough may be produced on palpating the mass. This is a clinical sign, unique to vagal schwannoma. Presence of this sign, along with a mass located on the medial border of the sternocleidomastoid muscle, should make clinicians suspicious of vagal nerve sheath tumours. However, in our case, the patient presented to us with a swelling in the neck and no other symptoms. MRI in the pre-operative work-up is helpful in defining diagnosis and in evaluating the extent and the relationship. A careful intracapsular enucleation with nerve-sparing technique remains the treatment of choice in order to avoid nerve injury which can lead to vocal cord paralysis. Horner’s syndrome following cervical surgeries is a rare phenomenon. Its occurrence following excision of a vagal schwannoma can occur due to direct injury to cervical sympathetic chain during excision or indirect injury due to traction on the sympathetic chain. Here is a case report of a patient diagnosed with left vagal scwanomma who developed horner’s syndrome post operatively.
Effect of alcohol swabbing of venepuncture site on blood alcohol estimation: A literature review
Authors: Taiya H.S , Vaidya H.V , Tawara A.A , Jadhav Y.T , Bandgar A.L
Published: July 2021

Estimation of blood alcohol concentration is one of the very important investigations in medico-legal cases dealing with drink and driving, alcohol toxicity etc. There are many factors which may influence estimation of blood alcohol concentration of an individual. One of these factors is thought to be application of alcohol containing swab at venepuncture site, prior to collection of blood for alcohol estimation, either by gas chromatography or by enzymatic assay. Alcohol content of swab, either plain ethanol or iso-propyl alcohol, is said to influence blood alcohol estimation, to a significant extent, is a very common information rather misinformation given to all medical practitioners worldwide. Unfortunately, Courts of Law, in India also have to believe on this, and in many cases defence try to create benefit of doubt, using this information. It is commonly learnt and taught to Medical graduates, that while collecting blood samples from an individual for Blood Alcohol estimation, spirit swab should not be used for cleaning area of venepuncture. This is due to reason believed so far, that alcohol swabbing of venepuncture site can alter Blood Alcohol Estimation significantly. However there is no any study advocating this theory. Moreover review of literature pertaining to this subject has shown studies, which tend to prove that this concept is nothing but a myth and one has to be very particular to prove alteration in blood alcohol concentration due to alcohol swabbing of venepuncture site. Secondly, the literature and curricular statements in Forensic Medicine, which is written long back, needs exhaustive changes, and should be more evidence based.
Profile and pattern of post-mortem cases in mortuary of district hospital (associated with government medical college, Vidisha). — A cross-sectional study
Authors: Choudhary Nidhi , Singh Narendra , Nigam Manish , Gour Vinayak , Yadav Vikas , Dohre Sharad
Published: July 2021

The present study is a record based study of Post-mortems performed at Mortuary of District Hospital (Associated with Medical College) Vidisha, MP, India, from January 2018 to December 2018 comprising 330 cases. This study was conducted to determine and evaluate the socio-demographic profile of different types of cases and to assess the nature and cause of their death. Of these cases 247 (74.84%) were males, 54 (25.15%) were females and 276 (83.63%) were identified whereas 54 (16.36%) were unidentified. Accidental deaths were commonest 142(43%), then death due to poisoning 98(29.69%). Pathological deaths were 36(10.89%). Death due to assault were less common 24 (7.27%).
Institutional problems in the indian judicial system relating to admissibility of scientific evidence: Causes and remedies
Authors: Parveer Anjum , Verma Sandhya
Published: July 2021

Problems with Justice are many although the object of every criminal Law is Justice, because Administration of Law always seeks to fair conclusion of Criminal Litigation. However, there are many stakeholders like Police, Court and State and also Prosecution and Accused in this process, who according to their interest make all out attempt to drag the course of Court proceeding towards the ends favourable to them. This article analyzes these sorts of institutional problems in the field of Admissibility of forensic evidence.
Clinical and forensic aspect’s of the cocaine body packer in senegal
Authors: Bigot C. , Ngongang F.O. , Nseme E. , Soumah M. , Sando Z.
Published: July 2021

This study aims to describe the clinical and forensic features of the cocaine body packer in Senegal.

This research work is a retrospective and descriptive study. It was conducted based on 19 suspect cases attended for medical care at the Hospital of tambacounda.

Suspects were exclusively male subjects, aged 24 to 33 years and Nigerian citizens. All of them were asymptomatic. Pelvic touch was positive in 42.1% of cases. Abdominal radiography pointed out that all the suspects presented with damage (100%). The average number of drug pellets carried per person was 43+/- 20 units.

Body drug packing is a reality in Senegal. Narcotic drug policies should invest in capacity building by financing effective diagnostic tools.
Sudden unexpected death due to hereditary angioedema — A case report
Authors: Narayanan S , Ramalingam S , Narendar R
Published: July 2021

Angioedema related to deficiency of the C1- esterase inhibitor protein (C1-inh) is characterized by lack of response to therapies, which include antihistamines, steroids and epinephrine. In case of laryngeal edema, mortality rate is an estimated mammoth 30 percent. The first case of such acquired form of angioedema related to the deficiency in C1- esterase inhibitor was published in 1972. In the present case, we entail details of one such case.,
Study of patients with Pseudoexfoliation syndrome undergoing cataract surgery
Authors: Srinivasan G , R Deepa
Published: July 2021

To analyze the visual outcome in patients with pseudoexfoliation and to know the surgical parameters to cogitate in patients with pseudoexfoliation syndrome.

An Observational study which was conducted in the Ophthalmology department in a tertiary care hospital in a rural area from June 2019 to December 2019. A total of 52 eyes of 52 patients aged 40 years and above, of either sex, clinically diagnosed with senile cataract and associated with pseudoexfoliation were enrolled in the study. After assessing best corrected visual acuity (BCVA), a detailed anterior and posterior segment examination was performed along with lacrimal sac syringing, manual keratometry, contact A-scan biometry and intraocular lens (IOL) power was calculated. All patients underwent manual small incision cataract surgery under peribulbar anaesthesia and intraocular lens was implanted. Intraoperative complications were noted during the surgery and was reported .Best corrected visual acuity was recorded on day 1, at 1week and at 1 month of follow up.

Out of 52eyes of 52 patients, 29 were females (55.76%) and 38 eyes (73.07%) exhibited bilateral involvement. Distribution of the PXF material in various ocular structures was observed and majority of them (36.53%) had PXF material equally in iris, pupillary margin and lens. Based on the morphology of cataract associated with psudoexfoliation, nuclear cataract was the most commonly observed in 16 eyes (30.76%) and 42 eyes (80.76%) had moderate pupillary dilatation. The intraoperative difficulties observed during cataract surgery was poor pupillary dilatation which was managed by controlled sphincterotomy during the surgery in 3 eyes (5.76%), Iridiodialysis, rhexis extension, zonular dialysis each in 1 eye and posterior capsular rent in 2 eyes. Around 92.30% of the total study population achieved post-operative BCVA of 6/12 or better at 1month of follow up. Decreased visual acuity was noted in 2 (3.84%) eyes due to persistent corneal edema, one eye (1.92%) had posterior capsular opacification and one eye (1.92%) had cystoid macular edema.

This study concludes that with careful preoperative assessment and necessary intraoperative precautions, good visual outcome can be achieved in patients with cataract with pseudoexfoliation.
Travoprost versus latanoprost or timolol in primary open angle glaucoma- Efficacy and safety profile
Authors: Prasad Mukta , Ranjan Abhishek , K Sugyani Satapathy
Published: July 2021

Glaucoma is progressive optical neuropathy which is challenging to treat despite advances in medical and interventional mode of treatments. Primary open angle glaucoma(POAG) is generally associated with diabetes mellitus and hypertension. Any ocular topical pharmacological agent which is to be used in POAG to maintain intraocular pressure have to be very efficacious with good safety profile. We conducted a study comparing travoprost with latanoprost and timolol as single therapeutic agent having favorable outcome.

Seventy five patients were included in the study for a period of two years. After ethical clearance, patients were randomly allocated to three groups of treatment arm having 25 patients in each group. IOP was noted at 8 A.M, 10 A.M, 4 P.M on two eligibility visits for the same eye. Data collected included demographic data, blood pressure, visual acuity, ocular hyperaemia, Slit lamp finding, IOP & fundus examination.

Travoprost treated patients had minimum IOP significantly lower at all visits than those using timolol (p<0.0001) and latanoprost (p<0.004). Also, Travoprost treated patient had maximum IOP records significantly lower at all visits than those using timolol (p<0.0001) and those using latanoprost (p<0.02). No significant difference was found between travoprost and latanoprost treated patients (p<0.25) while patients treated with timolol had on average a higher IOP variance (p<0.004) suggesting a lower peak control during the day.

TRAVOPROST 0.004% once daily or in combination with other agents is the most effective and safest topical agents for patients of primary open angle glaucoma with the best safety profile.
Glaucoma characteristics evaluation in myopia – A clinical study
Authors: Rosita J Helen , J Gnanaselvan , S Amudhavadivu , Kurian Mullasseril Anna
Published: July 2021

Glaucoma is the leading cause of irreversible blindness, one of the risk factor recognised being high myopia. Intra ocular pressure may be normal in myopic patients, with optic nerve head glaucoma characteristics. Eye ball elongation and optic nerve head tilting may be present in patients with high myopia that will represent field defects mimicking glaucoma. Treating patients with myopia having suspected aspects of glaucoma may be a challenge but even more challenging is the diagnosis of glaucoma in myopic patients.

: To evaluate the association of glaucoma features with myopia. To create the awareness regarding the long term follow up.

: Patients in the age group of 15 to 45 years who had attended our institution over a period of one year who fulfilled the inclusion and exclusion criteria were subjected for this study. Fifty four patients who were diagnosed to have moderate or high degree myopia were selected for this analytical study. They were subjected to vision, ocular examination, tonometry and results obtained were analysed.

: In our study moderate myopes constituted 55.5% and high myopes were 44.5%. The mean Intra ocular pressure and the mean corrected Intra ocular pressure in high myopes were observed to be higher than in moderate myopia. It was observed that higher prevalence of glaucoma was observed in high myopes.

: There is a clinically as well as statistically significant difference between mean Intra ocular pressure and mean corrected Intra ocular pressure. So mean corrected Intra ocular pressure should be measured .From our study, there is a clear indication that there is increased prevalence of glaucoma in high myopes.
Diffuse infiltrating retinoblastoma: A diagnostic conundrum
Authors: Bhattacharjee Harsha , Mehta Aditi , Das Dipankar , Bhattacharjee Kasturi , Barman Manabjyoti , Kuri Ganesh Chandra , Deka Hemlata , Deori Nilutparna , Venkatraman Vatsalya , Deka Apurba
Published: July 2021

Diffuse infiltrating retinoblastoma (DIR) is characterized by absence of intraocular mass, lack of calcification. It may mimic inflammatory uveitis or exudative retinopathy.

An eight-years-old boy presented with progressive loss of vision in left eye. Clinical evaluation revealed neovascular glaucoma with a yellow–gray fundal glow, exudative retinal detachment, subretinal exudation and telangiectatic vessels. The presentation was consistent with exudative retinopathy (Coat’s disease) but for the presence of a family history of retinoblastoma in the younger sibling. Despite the absence of an intraocular mass or calcification on multimodal imaging, the enucleation was done on the basis of clinical suspicion of retinoblastoma. Histopathology confirmed a diagnosis of DIR.

: DIR can pose a diagnostic challenge due to its non-characteristic clinical and imaging features and atypical presentation. A high index of suspicion along with a positive family history was key to diagnosis in our case; histopathology was confirmatory.