bluuebunny/crossref_metadata_2025 huggingface dataset:
Unruptured tubal ectopic pregnancy: analysis and management
Authors: Lewis Preeti F. , Rudrakar Ashwini Pundlik , Bavdekar Nitin Bhimrao , Singh Nikita Brajkishore
Published: July 2022

Background: From its indirect reference by Abulcasis and till the nineteenth century the ectopic pregnancy was known as a universally fatal accident. Many patients with early resolving ectopic pregnancies escape surgical treatment. Preservation of future fertility became possible with the introduction of conservative surgical procedures and with the use of methotrexate. Aim and objectives of the study were: to analyse the age group, gravida, risk factors, clinical presentation, treatment given and outcome of the unruptured ectopic pregnancy.Methods: We studied twenty-five women admitted to our tertiary care hospital, through emergency or outpatient department with tubal ectopic pregnancy from January 2017 through September 2021.Results: 25 cases were studied during a 5 years study period between January 2017 and September 2021 in a tertiary care hospital, Mumbai. Maximum incidence of tubal gestation occurred between the age group of 36-40 years (36%). Greater incidence was noted in multigravida accounting for 68%. Risk factors seen were advanced maternal age (36%) previous history of induced abortion (24%), previous history of abdominal or pelvic surgery in 20%. The typical triad of amenorrhoea, pain abdomen and bleeding were observed in majority of cases. Significantly a greater number of cases had ampullary pregnancy (52%), followed by cornual (24%) and fimbrial (24%). Out of 25 cases of unruptured tubal ectopic pregnancies, 68% cases were treated by purely surgical intervention while 8% cases were managed medically by methotrexate however in 24% cases, the medical treatment failed and they ended up having surgical intervention.Conclusions: In conclusion, this study showed that medical treatment of unruptured ectopic pregnancy with systemic methotrexate seems to be an option for some patients with unruptured tubal pregnancy.
Menstrual irregularities and related risk factors among adolescent girls
Authors: Varghese Linda , Saji Akhila , Bose Parvathy
Published: July 2022

Background: Irregular menstrual cycle is a common issue faced by females in their reproductive age group. Problems associated with menstruation are really challenging faced by adolescent girls. Females face various problems associated with menstruation once they attain puberty. The main aim of the study was to identify menstrual irregularities and related risk factors among adolescent girls in selected district, Kerala.Methods: Descriptive survey design and total enumeration sampling technique was used for the study. The study was conducted in 356 adolescent girls between the age group of 17-22 years. Data was collected by using a semi-structured questionnaire.Results: The mean age of the adolescent girls was 20 years. Majority of them belong to middle-class family (97.2%) with normal BMI (68%). 84% (299) girls have regular menstrual cycle and 16% of the girls have irregular menstrual cycle. Only 24 (6.7%) of girls have amenorrhea. Considerable number of adolescent girls 51 (14.3%) had light menstrual flow. More than half (65%) of the adolescent girls had menorrhagia. Polymenorrhagiais experienced by 11 (3.1%) of adolescent girls. Dysmenorrhea was present in 264 (94%) girls followed by menometrorrhagia (16%) and oligomenorrhea (14.9%).Conclusions: Menstrual irregularities are very common in reproductive age group of females and the common menstrual irregularities found were dysmenorrhea, oligomenorrhea and menometrorrhagia. Hypomenorrhea and menometrorrhagia has significant association with age.
Selective allocation of patients with vaginal apical prolapse to either mesh augmented open abdominal repair or vaginal sacrospinous colpopexy improve functional and anatomical outcomes
Authors: Hassan Mahmoud F. , El-Tohamy Osama , Yehia Amr Helmy , Alghanimi Salha A. , Al-Enezi Hessa , Moussa Mahmoud
Published: July 2022

Background: To evaluate the functional and anatomical outcomes after allocation of patients with apical vaginal prolapse to either mesh augmented abdominal repair or vaginal sacrospinous-colpopexy based on proposed selection criteria.Methods: A non-randomized trial was conducted at Ain-Shams university maternity hospital on patients with apical vaginal prolapse stage ≥2 based on pelvic organ prolapse quantification system. Certain criteria were proposed for patient selection to either mesh augmented abdominal repair or vaginal sacrospinous-colpopexy. Seventy-eight patients were assigned for sacrospinous-colpopexy and 47-patients for abdominal repair. Primary outcomes were the functional outcome using urogenital distress inventory questionnaire and patient global impression of improvement (PGI-I). Both were measured at 1-year’s follow-up. Secondary outcomes involved the anatomical success (defined as no apical prolapse ≥POP-Q stage 2), perioperative data and long-term complications.Results: There was improvement in all UDI domains for sacrospinous-colpopexy and abdominal repair groups with genital prolapse domain of median (interquartile range) 0 (0-10), 0 (0-0) respectively. Eighty-nine percent of abdominal repair group and 85% of sacrospinous-colpopexy group reported scale of 1 or 2 on PGI-I scale at 1-year follow-up. PGI-I score and improvements in UDI domains were maintained till 5-year follow-up. The anatomic success rate at 1-year follow-up was 97.9% in abdominal repair group and 78.2% in the sacrospinous-colpopexy group. No long-term mesh complications were detected in mesh augmented abdominal repair over the whole follow-up periods.Conclusion: The resulting meritorious functional and anatomical outcomes favor adoption of our proposed selection criteria in the initiation of guidelines and recommendations for managing vaginal apical prolapse.
Placenta previa percreta: a case report on diagnosis and management
Authors: Aafreen Asna , Pankaj Apoorv , Pankaj Aprajita
Published: July 2022

A 37-year-old female patient, G2P1L1, previous caesarean section, presented at 27 weeks of gestation, with the chief complaint of spotting per-vaginum, not associated with pain in the abdomen. The ultrasound performed was s/o placenta previa with placenta increta. She presented with similar complaints on and off during the second trimester and was treated conservatively. Follow up scans revealed placenta percreta and the pregnancy was electively terminated at 33 weeks. A multidisciplinary team, consisting of a urosurgeon, a gynaecologist and an interventional radiologist were present during the procedure. The patient recovered fully.
Transmigration of intrauterine contraceptive devices: embedded in urinary bladder wall in pregnant woman
Authors: Mavintop Prajna K. , Kumar Ramesh , G. S. Sneha
Published: July 2022

Globally, 14% of reproductive aged women use intrauterine contraception. The five intrauterine contraceptive devices (IUCDs) currently approved are chemically active and continually elute either copper or levonorgestrel. Uterine perforation is most serious and rare complication which can be acute or chronic in nature. Although uncommon, uterine embedment and perforation can occur. We report case of transmigration of intrauterine contraceptive device into the urinary bladder wall perforating the uterine wall in 25-year-old gravid female. She was subjected to ultrasound abdomen and pelvis which unveiled the diagnosis of migrated copper-T. Under spinal anaesthesia, laparotomy was done and IUCD was removed.
Induced labour in pregnancy with congenital abnormalities: clinical indications or patient demand
Authors: Pribadi Adhi
Published: July 2022

Congenital abnormalities are a nightmare for a pregnant woman. However, congenital abnormalities are divided into several conditions. The state of major disability is the worst situation, with the possibility of disability and even postpartum death. The disability is still a pregnancy that can cause complications that have a bad effect on the mother, so the pregnancy is often induced labor for fear of endangering the mother even though the complications have not yet appeared. In addition, it often happens because the family refuses the presence of a child with a disability. Criteria and references for intrauterine anomalies have been made by various countries and organizations, with the treatment taking into account clinical, psychosocial, religious, and legal aspects. However, this reference is not always easy to implement due to various factors, so that the decision to induced labor or induced abortion is always based on the advice of the medical team and family approval without leaving the legal aspect. Parental consent is important because not all pregnant women agree to induced labor of pregnancy even though it is a major disability and threatens postpartum death. On the other hand, if the defect can be corrected, then a clinician must be able to maintain the pregnancy and refuse unnecessary attempts to terminate the pregnancy.
European policies on same-sex relationships, adoption and assisted reproduction
Authors: Brandão Pedro
Published: July 2022

Same-sex civil union, marriage, adoption and access to assisted reproduction have progressively been more accepted worldwide. However, many differences exist in national legislation regarding the matter. This work is a review of current national policies of 31 European countries, including all the European Union, Iceland, Norway, Switzerland and the United Kingdom. At the moment, many European countries recognize same-sex civil unions, marriage and adoption, as well as the access of single women and lesbian couples to assisted reproduction, specially the northern and western countries. However, there is still an important number of countries where there is no official recognition of gay partnerships and adoption, and fertility treatments are exclusive to heterosexual couples. In addition, given the need to surrogacy, male couples have quite limited options concerning assisted reproduction in Europe. Europe is progressively allowing same-sex couples to legalize their relationship and to open adoption and assisted reproduction to everyone, regardless of gender, sexual orientation or marital status.
Practices of face mask use and associated factors during COVID-19 pandemic among school-going children in Shimla city
Authors: Sharma Deepak , Sharma Naveen , Sharma Ashna , Sood Ambika , Sharma Rakesh
Published: July 2022

Background: The aim of the study was to determine the practices of face mask use and associated factors during the COVID-19 pandemic among school-going children in Shimla city.Methods: An observational study was performed in October 2021 to November 2021, with 703 students chosen using a simple random sampling procedure in Shimla city. Data was collected based on observation and analyzed using Epi info version 7. To predict the relationship between the student mask-wearing compliance and its associated factors, a univariate analysis was done.Results: A total of 703 students, 41.8% (n=294) were males while 58.2% (n=409) were females, 40.5% (n=285) <15 years while 59.5% (n=418) >15 years of age. 97.2% (n=683) were Hindu and 72% (n=506) were studying in Government schools. All of the observed (100%) were wearing masks. 76.2% (n=536) students were using cloth mask, 12.1% (n=85) N95 masks while 11.7% (n=82) surgical masks. 81.8% (n=575) covered their mouth, as well as nose, 3.7% (n=26), had masks below the chin, 2.6% (n=18) had only their mouth covered while 11.9% (n=84) had partially covered their nose. Cloth mask was considerably more used by girls besides that there was no significant difference in the type of face mask according to age, standard of class, father’s occupation and type of school. The face mask was significantly more appropriately used by the students <15 years old and studied in junior classes, there was no significant difference in mask-wearing habits according to gender, father’s occupation and type of school.Conclusions: Every student was wearing a mask, and most had good face coverage. School authorities should plan and implement IEC activities, about, types of face masks and their proper usage.
A study of prevalence of peripheral neuropathy in patients with impaired glucose tolerance
Authors: Gupta Sumit , Sundaramurthy Harsha , S. C. Nemichandra , Paneyala Shasthara
Published: July 2022

Background: It is estimated that about half of the diabetics develop diabetic peripheral neuropathy (DPN). Prediabetes is the precursor of type 2 diabetes and it is projected that by 2045 nearly 8.6% of the global adult population may be affected by prediabetes. Pre diabetics also shares the vascular complications of diabetes. Evaluation of impaired glucose tolerance (IGT) and its association with neuropathy is hence very essential. According to International Diabetes Federation, number of global impaired glucose regulation (IGR) patients will reach 471 million by 2035. It is imperative that management strategies aimed at timely diagnosis and prevention of these complications be framed.Methods: 30 patients with IGT were recruited from outpatient/inpatient department of JSS hospital who met the following WHO diagnostic criteria (HbA1C of 5.7-6.4%, fasting blood sugar of 100-125 mg/dl, oral glucose tolerance test (OGTT) 2-hour blood sugar of 140-199 mg/dl) were included in the study. All the patients underwent nerve conduction studies as per the established clinical practice and results were compared with the standard values of our laboratory.Results: 13 patients (43.33%) had neuropathy based on nerve conduction studies (NCS). Sensory neuropathy (53.85%) was most common followed by motor and mixed types with 3 patients each (23.08%).Conclusions: Prevalence of neuropathy was high in prediabetics. Small fibre involvement as manifested by sensory component was predominant in our study. Family history of diabetes was an important risk factor associated with higher neuropathy prevalence.
Pattern of neck metastasis in carcinoma of oral tongue-a prospective study of north eastern people
Authors: Saikia Jyotish , Sarma Mridul Kumar , Deka Muktanjalee , Bharadwaj Barasha Sarma
Published: July 2022

Background: North eastern part of India is one of the most vulnerable regions for all sites of cancer. There is various literature regarding the pattern of cervical metastasis from different sub sites of oral cavity, however there are very few studies from the north eastern part of India, which reports one of the world highest number of cases. The aim and objectives of this study were to study the pattern of cervical lymph node metastasis in relation to prognostic factor like histological grading, laterality, depth of invasion, lymphovascular and perineural invasion and worst pattern of invasion.Methods: A prospective study of 20 patients who had undergone surgery for carcinoma of oral tongue was conducted in State cancer institute in department of Head and neck oncology from January 2020 till June 2021. Out of 20 patients included in the study 6 (30%) were females and 14 (70%) were males. Results: Clinically 9 patients had palpable nodes but pathologically nodes were positive in 10 patients whereas when a node was clinically not palpable in 11 patients, patients was pathologically nodes negative only in 10 patients.2 patients had isolated II involvement. 1 patient has I(b) and level II involvement. 4 patients had level II and III together. Two patients had level II and level IV involvement. 1 patient had level I(A), I(B), III and IV involvement. None of the patient had level 5 involvements.Conclusions: DOI, WPOI and tumor differentiation are the important prognostic parameters. We would also like to suggest surgical excision of the tumor and measurement of WPOI, DOI and assessment of histological grading to be done from frozen section for determining the type of neck dissection in T1/T2 N0 cases.
Role of tocilizumab therapy in COVID-19 patients: a systematic review and meta-analysis
Authors: Srikumar Shabarini , Muthiah Aravind , Perumal Shridharan
Published: July 2022

The rapid global spread of corona virus disease has created an adversity for the scientific community in managing the disease with appropriate therapeutic measures. The use of remdesivir was initiated as an experimental drug and the later studies analyzing its efficacy showed mixed results. In this meta-analysis, we systematically review the efficacy and safety of remdesivir for the treatment and prevention of COVID-19. A systematic search of databases such as Pubmed, Lancet, Medline, Google Scholar, Cochrane, Embase was carried out through which 1451 articles were identified. 8 articles among it were finally taken for the meta-analysis after several stages of exclusion, to improve the quality and accuracy of the results, out of which the results of 4 studies were in favour of the efficacy of remdesivir, while other 4 studies were against the efficacy of remdesivir. The total sample size is 12,028. The result of our statistical analysis was that OR=0.965 (95% CI; 0.6633 to 1.47) for the effect of remdesivir on mortality reduction in COVID-19 patients. Remdesivir therapy for COVID-19 did not show reduced time to clinical recovery or improved mortality rate. Other outcomes of study like requirement of oxygen support, easier weaning off of mechanical ventilation were also not significantly improved with administration of remdesivir in critically ill COVID-19 patients.
Atopic dermatitis and role of Relizema: a multi-country user experience
Authors: Kwong Cheong W. , Pellacani Giovanni , Varothai Supenya , L. Palmero Ma , Prihianti Srie , Tan Frances , K. Fon Leong , K. Keung Ho , Yung Chan , Munasir Zakiudin , Braganza Lisa
Published: July 2022

Atopic dermatitis (AD) is characterized by itching or pruritus, erythematous lesions, pruritus, and a skin barrier defect. Repeated scratching can trigger the itch-scratch cycle. Itching is associated with an adverse impact on quality of life. The first-line treatment of AD includes the use of topical corticosteroids for atopic dermatitis. However, parents of children with atopic dermatitis are often reluctant to accept the use of topical corticosteroids due to their concern of adverse effects flare-up. Relizema™ cream is a prescription emollient device (PED) multi-ingredients moisturizer formulation that has been indicated for the treatment of signs and symptoms of dermatitis. It is approved as medical device (MD) class IIa in Europe and it is registered as a topical medical device in countries of Asia Pacific. A consensus meeting of 9 dermatologists from multiple countries in Asia Pacific region treating atopic dermatitis was conducted. The dermatologists presented their cases of atopic dermatitis. PED was reported by patients to offer good relief of symptoms and improve skin softness unlike other moisturizers. In fact, a few patients reported relief with Relizema™ cream after using other moisturizers which were not demonstrating clinical effectiveness. Patients reported they noticed a softness in their skin after the application of the PED. PED was effective even in patients with lichenified skin. The formulation which is enriched with antioxidants helped relieve eczema. Due to its steroid-free formulation, the PED can be continued as a part of long-term maintenance treatment to maintain healthy skin conditions, prolong remission, and prevent recurrence.
Late gastric twist after laparoscopic sleeve gastrectomy
Authors: Lopez Elsa Paulina Alonso , Sahagun Cesar Manuel Vargas , Ortiz Cesar Antonio Martinez
Published: July 2022

Gastric sleeve twist is a rare complication, with an incidence of 1.2%. Its symptomatology is not very specific, making its diagnosis difficult to establish. Its timely treatment by endoscopy and/or surgery has shown excellent short- and long-term results. We present an infrequent and rare case of late gastric torsion 10 years after a laparoscopic gastric sleeve, which was resolved with surgical treatment with conversion to Laparoscopic Roux-en-Y Gastric Bypass with excellent results.
Malignant psoas syndrome: first pediatric case report in Mexico
Authors: Jorge Iván Martínez-Restrepo , Georgina Velasco-Pérez , Angelica Duarte-Castro , Stefanie Martinez-Restrepo , Héctor Francisco Villa-Santiago
Published: July 2022

Malignant psoas syndrome (MPS) is a rare, painful condition caused by malignant infiltration of the psoas muscle and adjacent nerves, causing fixed flexion of the leg over the hip. Unfortunately, it is often underdiagnosed. We presented the case of an 8-year-old girl with a clinical history of lumbar embryonal rhabdomyosarcoma and high-grade sarcoma presenting as MPS. To the best of our knowledge, this is the first pediatric case   report described in Mexico.
Factors affecting prognosis in signet ring cell gastric cancers with expanded lymph node dissection; high volume centre experience
Authors: Culcu Serdar , Tamam Selim , Unal Ali Ekrem
Published: July 2022

Background: Signet ring cell gastric cancer differs from gastric adenocarcinoma in terms of demographic and clinical features, age, gender, tumour grade and stage. In this study, we aimed to evaluate the clinical features and overall survival of gastric signet ring cell carcinoma and the prognostic factors affecting survival.Methods: We analysed 138 patients who were operated on with the diagnosis of signet ring cell gastric cancer. The univariant and multivariate hazard ratios of these parameters were analysed and the factors affecting the long-term average survival outcomes were investigated.Results: We performed Cox regression univariate analysis to investigate the effects of clinicopathological factors on mean survival follow-up in signet ring cell gastric cancer. As age increases, the mean survival follow-up period decreases. This relationship is also statistically significant. Mean survival follow-up for the open technique was lower than for laparoscopic procedures. The mean survival follow-up time of patients with positive perineural invasion (PNI) and lymphovascular invasion (LVI) is lower than patients with negative LVI and PNI. We did not find a significant relationship between the hazard ratios (HRs) of tumour markers and systemic inflammatory response parameters. However, we found a significant relationship between the increase in fibrinogen value and HR.Conclusions: We investigated the clinicopathological features of nonmetastatic signet ring cell gastric carcinomas and identified predictors of long survival. Age, lymphovascular and perineural invasion, open surgery, higher tumor infiltration, and lymph node involvement were independent predictors of shorter survival times in nonmetastatic signet ring cell gastric cancers.
A step towards Lichtenstein repair as a day care surgery: spinal versus local anaesthesia
Authors: Chhabda Tejindersingh Tejpalsingh , Singhi Anuj Naresh , Wadhokar Pranav Satyajit
Published: July 2022

Background: Inguinal hernia repair includes 15% of the procedures in general surgery. Until now the conventional post-operative protocol was to keep patient admitted till the patient was completely mobilized and fit to return to daily activity. This leads to unnecessary occupancy of hospital beds and increased financial burden to the patients. Therefore, day care surgery or short stay surgery is the need of the hour, in which local anaesthesia can play a major part. The aim of this study was to analyse the outcomes of inguinal hernia repair with special emphasis on the use of local and spinal anaesthesia and to find out which among the two was regarded as an effective method.Methods: A randomised control trial was conducted at MGM medical hospital, Aurangabad over a duration of two years (November 2016 to October 2018) where 100 patients of uncomplicated unilateral inguinal hernia were included. 50 patients were given spinal anaesthesia and 50 patients were given local anaesthesia. Intra-operative and post-operative complications and recovery was noted.Results: The duration of surgery, post-operative pain and complications were significantly lesser in local anaesthesia group (p<0.0001). Post-operative mobilisation, micturition and starting of oral diet was significantly earlier in patients receiving local anaesthesia (p<0.0001). The patients in the local anaesthesia group were discharged sooner than the spinal anaesthesia group (p<0.0001).Conclusions: Thus, local anaesthesia has a major role in establishing inguinal hernia repair as a day care or short stay surgery. Local anaesthesia is a safe, efficient and cost-effective option for inguinal hernia repair compared to spinal anaesthesia in terms of patient benefits and patient satisfaction.
Traumatic gastrointestinal perforation following abdominal trauma: a study in tertiary care centre
Authors: Naqvi Raheel Hussan , Singh Gurbir , Saroch Taruna , Trakroo Sushant
Published: July 2022

Background: The objective of this study was to determine the cause and anatomical distribution of traumatic gastrointestinal perforation and its management.Methods: A prospective study was conducted in the department of general surgery in a tertiary care centre that has round the clock availability of all radiological investigations. A total 100 cases of the patients presenting with traumatic gastrointestinal injuries were enrolled in the study.Results: Maximum number (52%) of patients were aged between 21-40 years of age with males to be the most vulnerable group. Most of the patients (86%) presented with blunt abdominal trauma. Road traffic accidents (RTA) (44%) and fall (42%) were the common causes of gastrointestinal injury. Most common site of injury was jejunum accounting for 66%. 72% of the patients underwent primary closure, 12% underwent resection anastomosis and 16% underwent ostomy.Conclusions: RTA forms the most common mode of gastrointestinal injury. Blunt abdominal trauma is more common than penetrating abdominal trauma. Jejunum is the most commonly injured in gastrointestinal trauma. Early diagnosis and management are the key to decrease mortality and morbidity.
Spontaneous retroperitoneal hematoma in COVID-19 patients
Authors: Atanasov Teodor D. , Todorova Katya T. , Tsvetanov Alexandar I.
Published: July 2022

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel coronavirus that has led to a global pandemic and unfortunately has caused a health crisis. Severe coronavirus disease 2019 (COVID-19) can manifest with bilateral pneumonia and hypoxemic respiratory failure but also can affect different organ systems. Spontaneous rectus sheath haematomas and retroperitoneal haematomas are recognized, rare, complications of anti-coagulation therapy, including LMWH. A prompt diagnosis is important to antagonize anticoagulation and prevent further bleeding. Massive bleeding into the retroperitoneum represents a problem not only because of the loss of intravascular volume, but also because the increase in abdominal pressure may compromise perfusion to different organs, such as the liver, gut, and kidneys. We present 3 cases of severe spontaneous soft tissue hematomas (SSTH) in patient with SARS-CoV-2 infection, who were taking low molecular weight heparin for prophylaxis of DIC and venous thromboembolism. First one is 56-yeard-old female patient with retroperitoneal and extraperitoneal haematoma presenting with dysuria and haematuria, the second one is 67-year-old male patient with iliopsoas haematoma and the third one is 51-year-old female patient with rectus sheath haematoma. All patients were treated conservatively. Clinicians should be attentive about bleeding complications as retroperitoneal haematomas in COVID-19 patients on anticoagulant therapy. There is no consensus on management of retroperitoneal haematomas. Each decision as conservative treatment, embolization or surgery should be made according to the clinical stability of the patient and by risk and benefit assessment.
A case report on large retroperitoneal liposarcoma
Authors: Chaudhari Sandipkumar , Patel Brijesh , Patel Jimitkumar , Chaudhary Sonalben
Published: July 2022

Even though rare, retroperitoneal masses evoke interest for so many reasons. They involve a wide variety of tumor types, both malignant and benign, making the diagnosis a challenge. Many tumor types have different clinical behaviors and treatments. Surgical resection is always challenging technically with no fixed steps of resection. The <1% of neoplasms are soft tissue sarcomas in humans. Liposarcoma is the most common retroperitoneal sarcoma among the retroperitoneal malignant tumors. More often than not, patients report late to the hospital due to the very slow growth and the onset of a few late symptoms, patients usually present at a late stage to the health care. Therefore, in most cases, the tumor is known to have reached enormous sizes and might have infiltrated vital structures. Here, we reported a case of large retroperitoneal liposarcoma weighing more than 8 kgs.
Blue rubber bleb naevus syndrome: a rare presentation of vascular disorder
Authors: Dalal Parth R. , Parikh Jayesh V. , Patel Aquibjaved M. , Suratwala Pratikkumar T.
Published: July 2022

Blue rubber bleb naevus syndrome (BRBNS) is a rare syndrome of AV malformation which mainly involves skin, soft tissue, gastrointestinal tract and other parts of the body. Its occurrence is usually sporadic, although cases of autosomal dominant inheritance is reported. At presentation symptoms depend on the organs involved. Patients may present with acute or chronic gastrointestinal bleed and it usually seen in children and rarely in adults. We herein reported a rare case of BRBNS in 17 years old male patient who suffered from Malena for four years with past history of haemangioma excision on back. Patient was on regular blood transfusion for six months. Endoscopy revealed multiple AV malformation in gastrointestinal tract. Patient underwent laparotomy with resection of involved segments of ileum with primary end to end anastomosis. Post-operative recovery was uneventful. So here we can conclude that the definitive management of BRBNS affecting the gastrointestinal tract is excision. This article was an original case review of management of BRBNS. The clinical presentation, required investigations and management of the same.
Conservative management of traumatic pneumoperitoneum in a child
Authors: D'Souza Dyan , Kumar Prasanna A. R. , Mahadevaiah Shubha A. , Hegde Shalini
Published: July 2022

Clinical practice guidelines for blunt trauma abdomen in children and adults advocate exploratory laparotomy when free air is detected on imaging. This conventional algorithmic approach of taking up for surgery when pneumoperitoneum is picked up, has its pitfalls as is illustrated in the case study where a child with polytrauma was managed conservatively despite free air on computed tomography (CT). The role of CT to detect bowel perforation, reasons for false positivity of free air in the abdomen and the key points in the successful non-operative treatment of the child have been discussed. Unlike, the only other report in a child with conservative management of pneumoperitoneum where the pneumoperitoneum can be explained secondary to blunt trauma chest, our report was unique in having other markers of bowel injury on CT and was in the absence of chest trauma. Response to injury in children is different compared to adults and allows for a higher success rate in conservative management. Hence, clinical judgement may override trauma protocols in select cases.
Horse shoe anorectal abscess in pregnancy: fetus vs abscess
Authors: Bandeudda Santhoshkumar , Gopal Ajesh , Mohandas Anu
Published: July 2022

Anorectal diseases such as hemorrhoids and anal fissures are the common entities encountered during pregnancy. However anorectal abscess is uncommon condition warrants emergency surgery. There is a significant risk of adverse outcomes, premature birth, and fetal loss due to surgery. A strategic approach considering risk and benefit is required in managing such conditions. We report one such case of horseshoe abscess in a 19 years old pregnant lady.
Short-term effects of a health promotion program targeting healthy nutrition, physical activity and social network enhancement among low-income multi-problem households in the Netherlands
Authors: Abidi Latifa , Candel Math , De Vries Hein , Spaans Natalie , Nagelhout Gera E.
Published: July 2022

Background: Multi-problem households (MPHs) are less physically active, eat less healthy, have higher perceived stress and worse self-reported health. A health promotion program was developed for MPHs targeting self-reported health, physical activity, healthy nutrition and engagement in social networks. This paper described the effectiveness of this program.

Methods: A quasi-experimental study was conducted in the city Apeldoorn in the Netherlands with assessments at baseline and after six months. The primary outcome was self-reported health. Secondary outcomes were physical activity, fruit and vegetable consumption, social contacts, loneliness, mental health, BMI and lifestyle index. Data were analyzed with multilevel linear regression analyses.

Results: A total of 116 respondents signed up for participation, of which 90 respondents (77.6%) completed the follow-up questionnaire. No differences were found between the control and intervention group on self-reported health (p=0.84). No differences were found between the groups on fruit consumption (p=0.34), but a significant interaction of group×time×health literacy was found (p=0.02). Follow-up analyses showed that only for participants with high health literacy significant differences in fruit consumption were found between control and intervention group at post-test (ß=8.059, p=0.02). No significant differences were found on other outcomes.

Conclusions: Recruiting sufficient participants was a challenge. Significant differences in fruit consumption were found among individuals with a relatively high health literacy and none for the other primary and secondary outcome measures. Our outcomes indicate that health promotion programs, as well as their reachability, need to be further tailored to the needs of MPH.
Trial design and protocol of randomized controlled trial comparing the efficacy of combined letrozole and clomiphene versus only letrozole as a method of ovulation induction in women with polycystic ovarian syndrome (CCLOP trial)
Authors: Panda Soumya R. , Sharmila Vijayan , Kalidos Vinoth Kumar , Hota Smrutismita
Published: July 2022

Background: Both clomiphene (CC) and letrozole are commonly used oral ovulation induction agents, with different mechanism of action. Apart from letrozole or CC, options for ovulation induction in polycystic ovarian syndrome (PCOS) patients are limited and thus leaving the use of gonadotropin injections as the only option of ovulation induction in these patients. The objective of this study is to evaluate the efficacy of combined therapy of letrozole and CC compared to the use of letrozole alone to achieve ovulation in infertile women with PCOS.

Methods: This will be a single-centre, double arm, triple-blind randomized controlled trial. The study was conducted after taking approval from institutional ethics committee and was prospectively registered with the clinical trials registry- India. Women were randomly assigned to receive a combination of 2.5 mg letrozole and placebo daily or a combination of 2.5 mg letrozole and 50 mg CC daily on cycle days 3–7 for one treatment cycle.

Conclusions: If combination of clomiphene and letrozole is proved to be more efficacious than letrozole alone, there will be several breaks through advantages in the management of infertility. The novel method of ovulation induction with combined letrozole and clomiphene will bring down overall cost of infertility treatment.

Trial registration: The study is prospectively registered with the clinical trials registry- India CTRI/2020/09/028012.
Factors associated with nutritional status of under five children in Rara Chhayanath Municipaity, Mugu district
Authors: Chaudhary Pramodh , Malla Radha , Thapa Janak Kumar , Sangroula Raj Kumar
Published: July 2022

Background: Proper nutrition is crucial for healthy living. According to Nepal multi-indicator cluster survey 2019, prevalence of stunting, wasting and underweight were 31.5%, 12% and 24.3% respectively. The prevalence of under nutrition is higher in Karnali Province than other Provinces of Nepal. This study is conducted to assess the factors affecting the nutritional status of under five years’ children in Rara Chhayanath municipality, Mugu district.Methods: A community based cross sectional study was conducted in Rara Chhayanath municipality, Mugu district of Nepal which was purposively selected. Three wards were selected for collection of data. Verbal informed consent was taken from the mothers of the under five children and approval was taken from Little Buddha College of Health Science and Municipality. Bivariate analysis was performed to identify the factors associated with nutrition status of children. Results: In the study, prevalence of stunting and wasting were high as compared to national data i.e., 40.4% and 14.1% percent respectively. The study found that maternal education, family income, exclusive breastfeeding and minimum meal frequency were significantly associated with stunting and wasting.Conclusions: Socio-economic and child feeding practices were the associated factors of under nutrition. Programs should be focused on socio demographic and economic factors and child feeding practice to reduce problem of malnutrition.
A study on the prevalence of hypertension and its associated risk factors in Gandhinagar urban PHC, Jaipur
Authors: Bardhar Shubhra , Khanna Anoop , Bardhar Neha
Published: July 2022

Background: Hypertension is considered as an important public health issue around the world. It is associated with the development of more serious medical conditions like myocardial infarction, cardiac failure, stroke, renal disease, etc. According to the WHO, high blood pressure affects 1280 million adults aged 30 to 79 years worldwide and almost two-thirds of them come from low-middle-income countries. Methods: An OPD-based, observational study was conducted among individuals aged 30 years or above at Gandhinagar UPHC of Jaipur city in the state of Rajasthan. Prevalence of hypertension and prehypertension were analysed. The details regarding gender, age, family history of individuals and other behavioural characteristics like tobacco, smokeless tobacco and alcohol consumption, physical activity, and anthropometric measurements were collected. The Chi-square test was applied to analyze if a statistically significant association exist between hypertension and the above-mentioned factors.Results: This study estimated hypertension prevalence as 23.2%. The prevalence of prehypertension was estimated to be 33.2% and the prevalence of individuals with no-hypertension was 43.6%. This study also reports that obesity, consumption of alcohol, smoking and positive HTN family history were significant determinants for hypertension.Conclusions: Overall, the results of this study show that the HTN and pre-HTN prevalence was significant in the study population. In the absence of lifestyle changes, individuals referred to as prehypertensive are at high risk of developing HTN. Early detection and timely intervention will reduce the effect of high BP thus decreasing the risk of developing CVDs, stroke, and renal impairment.
Body image dissatisfaction among medical students in the Southern district of Kerala: a cross-sectional study
Authors: Siraj Mehna , B. Palappillil Merin , Varghese Merin , Manivarnan Megha , Saiji Alexander Merlin , Varghese Betsy , Prajitha K. C.
Published: July 2022

Background: Body image misconception can lead to behaviors that are detrimental to mental as well as physical health. Body dissatisfaction develops when people have negative thoughts about their body image. In this context, estimating the prevalence of body dissatisfaction would help in providing valuable information about those at risk of developing eating and other psychiatric disorders.Methods: A cross-sectional study was conducted among undergraduate students studying in a tertiary care government health institution in the southern district of Kerala. Data was collected using an online semi-structured questionnaire and was administered to 200 eligible participants. Data was analyzed using IBM SPSS statistics for windows (version 25.0. Armonk, NY)Results: Among the 200 participants in the study, 36 (18%) were found to have body image concerns without any significant gender predilection. Dissatisfaction with body image was seen to be more prevalent in those with higher BMI. There was a positive association between body image dissatisfaction and socio-cultural pressure to change body fat levels (p=0.001). It was also found that the tendency to skip meals was more among those with higher body image concerns (p=0.001). Conclusions: The study concluded that about one-fifth of the study participants comprising medical students have moderate to severe body image dissatisfaction without significant gender predilection. Dissatisfaction with body image was seen to be more prevalent in those with higher BMI. The focus should be on initiating educational programs to promote positive body image, and acceptance of self and individual differences while maintaining optimum weight and active lifestyle.
The association of age, gender, education and employment status with potential acceptance of a COVID-19 vaccine in Southern Kerala, India
Authors: Roy Layana , Mathew Seara M. , Raju Christin V. , Joseph Hannah , K. S. Jayakumar , James Roshiny Thankam
Published: July 2022

Background: Coronavirus disease 2019 (COVID-19) pandemic has affected most the countries causing a devastating influence on world health and economics since its appearance. The accelerated development of the COVID-19 vaccine has become vital, and early data suggests that it is both, safe and efficacious. However, the acceptance of the COVID-19 vaccine depends on several socio-demographic characteristics as well as people’s knowledge and misconceptions. The objective of current study was to access the associations of age, gender, and level of education with vaccine acceptance, from a random sample of 525 participants selected from Kerala, India.Methods: This is a cross-sectional study conducted by analyzing the data collected through a self-administered questionnaire that was shared online and directly across southern Kerala from January 2021 to June 2021. The survey questionnaire consisted of demographic characteristics of the respondents and queries pertaining to knowledge and acceptance of the COVID-19 vaccine.Results: The results of the study showed that the respondents showed a good level of knowledge and acceptance. We conducted this study to understand the attitudes towards COVID-19 vaccines and hesitancy to accept it based on age, gender and educational classification. The age group 18-38 has highest rate of acceptance. A higher rate of acceptance among males and people with higher educational qualification.Conclusions: This research results can be actively used in population segmentation into groups based on their attitudes and this understanding which can be used to develop targeted behavior change communication in improving vaccine acceptance campaigns.
Assessment of hearing outcomes in pre-adolescent cases of otitis media with effusion treated with adenoidectomy
Authors: Rajan Anoop K. , Ravindra Aditi , Sardesai Ishan
Published: July 2022

Background: Otitis media with effusion is one of the most common presenting features in children coming to the otorhinolaryngology outpatient with a variety of medical and surgical treatment modalities being offered. This study aims to evaluate post-adenoidectomy hearing outcomes in cases of otitis media with effusion in an attempt to provide long term benefits.

Methods: It is a prospective study of 50 pre-adolescent cases in a tertiary care hospital. Pure tone audiometry and tympanometry was performed pre-operatively as well as at regular follow up intervals after adenoidectomy (along with tonsillectomy when indicated). The mean improvement in hearing outcomes was evaluated.

Results: The mean hearing improvement when compared to baseline pre-op air-bone gap values were 8.4±6.35, 8.6±6.39, 8.1±6.99 at 15th day, 1 month and 2 months post op respectively. There was also a significant shift of tympanometry curves from types B and C pre-op to types A and B 6 months post-op.

Conclusions: Adenoidectomy, along with tonsillectomy when indicated, in children with hypertrophied adenoids as well as otitis media with effusion offers very good, long-standing hearing improvement and should always be considered in such patients so as to improve eustachian tube function and eradicate possible source of infection.

 
Comparative study of tympanoplasty using endomeatal approach using tragal cartilage and perichondrium with postauricular approach using temporalis fascia graft
Authors: Yamuna Katari , Lanke Sowmya
Published: July 2022

Background: Chronic suppurative otitis media is a disease which is a major cause of morbidity in our country. A large proportion of patients have safe (mucosal) chronic suppurative otitis media which leads to ear discharge and deafness which hampers the productivity of many individuals. Otolaryngologists play an important role in its correction and amelioration by conservative or operative procedures. One such procedure is tympanoplasty.

Methods: Patients of either sex having symptoms and signs suggestive of chronic suppurative otitis media and fulfilling the inclusion and exclusion criteria are taken for the study My sample size is 60 and these 60 patients were divided into 2 groups. A. tympanoplasty with temporalis fascia graft. B. tympanoplasty with cartilage island graft. 30 patients were included in each group.  

Results: In the cartilage island group, the graft uptake rate was 96.7% as compared to the temporalis fascia group in which the same was 90%. There is no significant difference in Air Bne gap between 2 groups.

Conclusions: Cartilage Island graft is as good a graft material as temporalis fascia for tympanoplasty.
Developing a ludic framework for counteracting interventions for dementia: A narrative and analytic review
Authors: Innamuri Raviteja , Deshbandhu Aditya , Kattula Dheeraj
Published: July 2022

As the field of medicine tries to tap into various facets of gamification, the potential of video games and gaming-based interventions has become a hotbed of interesting activity in the Dementia circles of medical research. This paper, exploratory in nature is a bid to find common grounds for the fields of neurosciences, psychology, and psychiatry with the sub-field of ludology in a hope to find unique insights from the benefits of interdisciplinary research and extrapolating findings from gaming addiction.

From the perspective of game studies, the paper will draw from elements of concepts like flow, immersion and engagement in a bid to understand the various tools that can be of use if people ailing from neurocognitive disorders were to engage in gaming activity. This paper will lay the framework that will enable the beginning of a matching gaming exercises based on cognitive deficits and psychological profiling of clients diagnosed with neurocognitive disorders and advance the fields of neurosciences and psychology.

By combining the findings from existing studies and original work this paper will propose both a means to study the possible effects of gaming-based interventions and suggest ways to streamline and optimize the use of gamification in patient care.