bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessment of eye health care services of Bangladesh using eye care service assessment tools
Authors: Hussain A.H.M. Enayet , Husain Lutful , Roy Abhijeet , Roy Tapash , Islam Rafiqul , Awlad Hossain Mohammad , Ahmed Munir
Published: January 2022

Background: Bangladesh is being the commissioner for oaths to vision 2020, a global campaign for elimination of avoidable blindness by 2020, formulated a national eye care plan. This report illustrates the present status of Bangladesh eye health care service using eye care service assessment tool (ECSAT) that assesses an eye health system across six ‘building blocks’ of a health system.Methods: The study followed a mixed method to collect data. World health organization (WHO) standard ECSAT was used to gather information on eye care service. A purposive sampling method was used. Data from the assessment were extracted and all the information was cross-checked with leading stakeholders of ministry of health.Results: Eye care planning is led by the national eye care. There is a national eye health action plan and a national eye health coordination office under the ministry of health. The health delivery system includes primarily government and non-profit facilities with eight hospitals delivering specialist eye care services across the country. A significant proportion of eye care is provided through community outreach camps and a network of primary and community health workers. The national cataract surgical rate (CSR) is estimated at 2600 per million populations per year.Conclusions: This assessment suggests that although Bangladesh has made some progress towards elimination of avoidable blindness, it would be difficult to retain without further significant investment with a transparent accountability framework in eye health considering all limitation and contemporary challenges.
Improving knowledge of street food vendors through an educational intervention in Kandy district, Sri Lanka
Authors: Wickrematilake M. S. K. , Arnold S. M. , Karthikeyan P. , Jayathilake A. D. N.
Published: January 2022

Background: Street food sector plays an important role in urban areas of many developing countries in catering to the needs of the urban population. Contamination of ready to eat food and beverages sold by street food vendors rendering them unacceptable for human consumption has become a global problem. The aim of this study was to evaluate the effectiveness of providing a health educational programme in improving knowledge related to food safety on street food vendors.Methods: Study used a quasi-experimental pre-test, post-test design. Evaluation instruments consisted of a questionnaire and a checklist. A total number of 427 street food vendors were included. A visual educational intervention was developed to provide training to all vendors in the intervention area. The study areas covered were method of food contamination, personal hygiene, safe food handling of potentially hazardous street vended food and time temperature control.Results: The results of the pre intervention survey showed that the baseline knowledge was poor. Vendors had unfavorable views particularly towards available facilities and support services. It was revealed that over 50% of the study population had received information on safe food handling though public health inspectors. Post intervention showed knowledge had improved significantly in the intervention group in all subject areas, when compared to control group (p<0.001).Conclusions: Health education intervention was effective in improving knowledge of the street food vendors in safe food handling practices and food borne disease prevention.
Home isolation, monitoring and follow-up as a management approach for mild to moderate COVID-19: a prospective observational study
Authors: Kilaru Satish Chandra , Chelluri Eswara Prasad , Chenimilla Nagender Prasad , Krishna Ramya , Dasari Pradeep kumar , Momim Kashif , Umair Syed , Thummanapally Kishan Rao , Toutireddy Narasinga Reddy , Tippani Ramesh
Published: January 2022

Background: The coronavirus disease 2019 (COVID-19) pandemic, caused by SARS-CoV-2 manifests as mild to moderate disease in about 80 per cent of the patients. Present study intends to know the clinical outcomes of treating this cohort, in home-isolation milieu.Methods: The 171 of 210 suspected COVID-19 patients conforming to inclusion criteria were enrolled and evaluated. Patients were categorized for severity assessment for the purpose of treatment plan, monitoring and follow-up. Data pertaining to clinical profiles, age grouping along with CT chest severity scoring, laboratory data and treatment allocations and outcomes were statistically analyzed.Results: Among 171 patients, mean age was 48.5 (±11.9) years and males were 108 (63%).  The 93 (54%) and 69 (40%) patients had moderate and mild clinical severity, respectively. The 107 (63%) had mild CT severity score and 83 (48.5%) had one or more comorbidities. Neutrophil lymphocyte ratio (NLR), C-reactive protein (CRP) and D-dimer levels were significantly higher in clinically moderate and above 45 years age groups (p<0.05). Overall outcome showed one in mild and 12 in moderate group needed hospitalization and all recovered completely.Conclusions: Home-isolation, treatment and monitoring of study cohort with mild to moderate COVID-19, helped in timely interventions and uneventful recovery of majority of the patients.
Role of magnetic resonance spectroscopy in grading of gliomas- a tertiary care centre study
Authors: S. Ajitha J. , Jose Teena , G. Unnikrishnan
Published: January 2022

Background: Grading of gliomas is important for the determination of appropriate treatment strategies. MR spectroscopy has found increasing utility in grading of gliomas.Methods: MR spectroscopic imaging was done for the referred patients to obtain Cho/NAA and Cho/Cr ratios. After analyzing histopathology reports, gliomas were classified into low grade and high grade. Histologically proven 54 low grade and 54 high grade gliomas were included in the study. The mean and standard deviation of these variables were obtained and compared between two groups.  ROC curve analyses were performed in order to identify the optimal cut-off value for metabolite ratios for prediction purposes of high grade versus low grade gliomas.Results: The mean and SD of Cho/NAA ratio in low grade glioma was 1.93±1.19. The mean and SD of Cho /NAA ratio in high grade glioma was 3.16±1.73 was significantly higher. The optimal cut-off for differentiating low grade and high grade gliomas was 2.15 with a sensitivity of 74.07% and specificity of 66.67%. The mean and SD of CHO/Cr in low grade glioma was 2.05±0.76. The mean and SD of Cho/NAA in high grade glioma was 2.87±1.65 was significantly higher. The optimal cut-off for differentiating low grade and high grade gliomas was 1.98 with a sensitivity of 64.8% and specificity of 64.1%.Conclusions: MR spectroscopy imaging plays a pivotal role in prediction of glioma grade preoperatively and helps in deciding appropriate treatment strategies.
Correlation of body mass index and waist/hip ratio with severity of coronary artery disease
Authors: Bhatia Ritu , Bhatia Ansh , Ganatara Keya
Published: January 2022

Background: Obesity assessed by body mass index (BMI) and waist/hip ratio (WHR) are better predictors of cardiovascular disease. However, there is a dearth of data investigating the correlation of BMI and WHR with severity of CAD, particularly among the Indian population. This study aims to investigate the correlation of BMI and WHR with severity of CAD assessed by angiography.Methods: This open-label observational study included patients who underwent angiography, angioplasty, or coronary artery bypass grafting in the past one month. All data such as age, gender as well as anthropometric measurements such as height (meters), weight (kg), and waist circumferences (cm), and hip circumferences (cm) were collected at the first follow-up visit. BMI (kg/m2), body surface area (BSA) (m2), and WHR were calculated. Angiography findings were retrieved from the patient’s own record to note the severity of CAD.Results: In total, 302 patients were analyzed. The mean age of the study sample was 60.5±11.5 years, and 71.9% were males. Mean BMI, BSA, and WHR were 27.0±4.3 kg/m2, 1.3±0.8 m2 and 0.96±0.07, respectively. BMI was not significantly correlated with severity of CAD (p=0.051). In both male and female patients, WHR was not significantly correlated with severity of CAD (male: p=0.256 and female: p=0.851).Conclusions: It has been concluded that BMI and WHR were not significantly correlated with severity of CAD in an Indian population.
A study of fetal anomalies: contribution of ultrasonography and magnetic resonance imaging
Authors: Vij Vineet , Chauhan Rahul Dev , Choubey Amit
Published: January 2022

Background: Ultrasonography (USG) remains the primary modality for fetal imaging. Magnetic resonance imaging (MRI) is a suitable adjunct to USG. MRI is currently not used as a primary screening tool for antenatal period; however, it provides a reproducible fetal anatomy and can be more informative when the diagnosis on antenatal USG is inconclusive. Aim of the study was to study the contribution of antenatal USG and MRI in diagnosing fetal anomalies at a zonal hospital.Methods: This was a prospective cross-sectional study enrolling the pregnant women between 13 to 35 weeks of gestation. The 30 consecutive fetuses suspected to have fetal anomaly on USG, were subjected to MRI after obtaining informed consent. Final diagnosis was made either radiologically (including follow up) or by clinical examination or autopsy.Results: In 30 cases, 31 anomalies were detected on USG. There were 14 anomalies pertaining to central nervous system (CNS), 05 anomalies of genitourinary tract (GUT), 04 anomalies of thorax, 03 anomalies of gastrointestinal tract (GIT) and, 05 anomalies involving other body parts of fetus. MRI could detect 28 anomalies. USG was able to characterize a case of dorsal meningo-myelocoele better than MRI. MRI was able to show the extent of other anomalies better than USG and provided additional information of horseshoe shape in 01 case of multi cystic dysplastic kidneys. MRI could not detect 03 cases of single umbilical artery.Conclusions: USG is the primary modality for fetal imaging. MRI can be a used as an adjunct to USG for confirmation and better delineation of anomalies.
Surgical anatomy of cervical sympathetic trunk: a cadaveric study
Authors: Manuel Nimmy , S. Lekha K. , Das Lola , N. Seena
Published: January 2022

Background: Cervical sympathetic trunk (CST) is at risk of injury during surgical procedures of cervical spine and may result in Horner’s syndrome. The purpose of present study was to clearly describe the surgical anatomy of CST with respect to the surrounding structures and to analyse the anatomical variations.Methods: In this cross-sectional study, 50 cervical sympathetic chains were studied by bilateral neck dissections of 25 formalin fixed human cadavers from the Department of Anatomy, Government medical college Thrissur.Results: Cervical sympathetic chain was found inside the carotid sheath in 1 (2%) side of neck. Superior cervical ganglion (SCG) was consistently seen in all sympathetic chains. Middle cervical ganglion (MCG) was present in 27 (54%) chains studied; vertebral ganglion (VG) was present in 33 (66%) chains. Inferior cervical ganglion (ICG) was present in 38 (76%) CSTs. In case of stellate ganglion (SG), it was present in 12 (24%) chains. The most common type of CST was type 1 consisting of SCG, VG and ICG (17, 34%). Out of 25 cadavers studied, sympathetic chain appeared similar on right and left sides in 14 cadavers.Conclusions: This study concludes that variations occur in cervical sympathetic chain with regard to occurrence and measurements of its ganglia. Our study also emphasizes the need for awareness of the CST’s anatomy during cervical surgical procedures to prevent inadvertent injury to it.
Cyto-histological correlation of salivary gland lesions- a prospective study in a tertiary care institute
Authors: Negi Soma , Mardi Kavita , Sood Shivani , Gupta Neelam , Mohindroo N. K. , Kumar Muninder , Azad Ramesh , Chaudhary Ashish , Negi Gunjita
Published: January 2022

Background: Fine needle aspiration cytology (FNAC) has an essential proven role in diagnosing most of the common and benign salivary gland lesions. However, limited cellularity and morphological heterogeneity of the lesion can pose diagnostic challenges. The present study was conducted in a tertiary care centre over a period of one year with an objective to study the cyto-morphological features of salivary gland lesions and correlate cytological findings with histopathology.Methods: The study was carried out over a period of one year from January 2014 to December 2014. FNA specimens obtained from 78 patients were analyzed. Of these, only 51 patients underwent biopsy or surgery and their specimens were subjected to histopathological examination. Validation of cytological diagnosis was done on the basis of histopathological diagnosis.Results: A total 78 patients with salivary gland lesions were subjected to FNAC. Non neoplastic lesions constituted 19 cases (25%) and benign lesions constituted 46 cases (80.70%).  Malignant lesions constituted 11 cases (19.30%). Two cases were inconclusive due to inadequate aspirated material. Overall sensitivity, specificity and diagnostic accuracy were 95.98%, 99.20% and 98.09% respectively.Conclusions: FNAC continues to be an accurate diagnostic technique in the hands of an experienced cytopathologist. It is a highly sensitive and specific technique for rapid diagnosis of most of the salivary gland swellings.
Study of salivary electrolyte in type 2 diabetes mellitus patients of North Gujarat region of India
Authors: Thakkar Jiger M. , Patel Dinesh C.
Published: January 2022

Background: A lack of literature on the probable relationship between diabetes and salivary electrolyte. Therefore, present study aims to study of salivary electrolyte in type 2 diabetes mellitus patients of North Gujarat region of India.Methods: The present cross sectional study was done on 60 subjects of diabetes mellitus (T2DM) and 60 subjects’ non-diabetic healthy controls at Banas medical college and our hospital. The subject’s demographic and anthropometric parameters were recorded; detailed history and clinical examination were performed in the entire cases. The saliva was collected in the fasting state during resting state. Salivary pH, flow rate, biochemical variables and electrolytes were analyzed. Data which was collected was statistically analyzed.Results: Predominance of the T2DM subjects was in the age group of 41-45 years. Mean value for age (p<0.05), body mass index (p<0.01), waist- hip ratio (p<0.05), salivary Potassium (p<0.001), glucose (p<0.001), Chloride (p<0.01), bicarbonates (p<0.01) and sodium levels (p<0.001) were significantly higher in the T2DM subjects where as salivary pH (p<0.01), flow rate (p<0.01) and calcium level (p<0.001) were significantly lower in the T2DM subjects.Conclusions: In our study, we conclude that significant variations were reported in salivary pH, flow rate and electrolyte variables between diabetics and non diabetics. Therefore, we suggested that estimation of salivary variables might be a cost effective and a non invasive choice for screening, diagnosis and monitoring of diabetes instead of blood.
Prevalence and pattern of amblyopia among children attending at tertiary eye care centre in Eastern India
Authors: Mondal Mobina , Ghosh Asim Kumar , Dutta Subrata
Published: January 2022

Background: The objective of this study was to determine the prevalence and pattern of amblyopia of children attending at tertiary eye care centre in eastern India.Methods: A cross-sectional study was conducted from April 2020 to May2021 among children (5-15 years age) at regional institute of ophthalmology, medical college, Kolkata, underwent visual acuity assessment, detailed ocular examinations and cycloplegic refractions.Results: A total of 500 children are taken in the study, out of which 264 (52.8%) were males. The age range was 5-15 years with 479 (95.8%) within the ages of 5 to 10 years. Amblyopia was detected in 57 (11.4%). Refractive amblyopia (58.4%) was the most common type of amblyopia out of which anisometropic amblyopia accounted for 74.6%. Unilateral amblyopia was observed in 80.5%. All the types of amblyopia were more common within the age group of 5-10 years.Conclusions: More common children are affected with amblyopia within the ages of 5 to 10 years with refractive amblyopia.
A study of cytohistological correlation of equivocal or atypical proliferative breast lesions at a tertiary care institution of North India
Authors: Kapil Raman , Gill Meenu , Malik Sucheta , Singh Lalit , Gupta Sumiti , Sen Rajeev
Published: January 2022

Background: Fine needle aspiration cytology is the mostly the first diagnostic test used for the diagnosis of breast masses. But there is morphological overlap among the sequential lesions from the precancerous group to frank carcinoma known as “grey zone”. This grey zone in cytology is estimated to constitute 8.9% of cases.Methods: Smears were prepared from the fine needle aspirates and stained with Leishman/Giemsa. Trucut biopsy, mastectomy or MRM specimens of patients diagnosed as having on cytology benign with atypia (C3) /suspicious of malignancy (C4) were subjected to histopathological evaluation and cytohistopathogical correlation was done in these cases.Results: 75% of patients who belonged to category C3 had benign lesions, whereas about 90% of those in category C4 had malignant diagnosis. This difference was statistically significant.Conclusions: Combination of the mammography and cytology along with the clinical findings (the "triple test") allows for proper management for each patient, determining which patient should undergo surgery and which patient needs close follow-up, hence avoiding an unnecessary surgery. And the patients in cytology category C4 must have the diagnosis confirmed by histological examination.
Imaging spectrum of extrapulmonary manifestations of COVID-19 infection- a multi-centre descriptive study from Southern India
Authors: Mahalingam Harshavardhan , Murali Lokesh , Govisetty Ashwini , Aiyappan Senthil Kumar , Ramakrishnan Karthik Krishna , Rajan Seena Cheppala , Rangasami Rajeswaran , Shanmugham Vinayagam
Published: January 2022

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) is the causative agent for coronavirus disease 2019 (COVID-19) pandemic. While the primary organ of involvement in this disease is the lung, multiple other organ systems can be involved either due to direct viral cytopathic effects or due to thrombo-inflammation and immune system dysregulation. In this study we describe the spectrum of extrapulmonary imaging findings encountered in our patients with COVID-19.Methods: This was a retrospective observational study conducted in three tertiary care hospitals in the city of Chennai in southern India. All cross-sectional imaging studies (other than lung imaging studies) performed in patients who had proven COVID-19 infection by RT-PCR testing during the period from April 2020 to March 2021 were included as part of the study. Extrapulmonary findings in these imaging studies were recorded and collated system-wise.Results: A total of 96 non-lung imaging studies were performed in patients who had RT-PCR positivity for COVID-19 infection. Among these a total of 30 studies had extrapulmonary imaging findings. Vascular involvement was seen in 14 patients, central nervous system involvement in 13 patients, abdomen involvement in 2 patients, and cardiac involvement in 1 patient. Vascular manifestations included arterial and venous thrombosis. Neurological manifestations included stroke, encephalitis and demyelination. Abdominal manifestations included enteritis and acute kidney injury. Cardiac manifestation was in form of myocarditis.Conclusions: Extrapulmonary imaging findings in COVID-19 are uncommon but not rare. Multisystem thrombotic manifestations and central nervous system involvement account for majority of extrapulmonary imaging findings in COVID-19.
A cross-sectional study of neutrophil to lymphocyte ratio as a reliable inflammatory index among hypertensives in Government Rajaji Hospital, Madurai
Authors: A. Poihai , A. Sivapriya
Published: January 2022

Background: Hypertension is a major risk factor to the development of atherothrombosis which is of major health concern today. Neutrophils and platelets play a significant role in the development of atherothrombosis leading to cardiovascular events. Presently, neutrophil lymphocyte ratio and platelet lymphocyte ratio which can be easily calculated from complete blood count have been identified as novel systemic inflammation based indices predictive of cardiovascular risk. This study attempted to assess the relationship between neutrophil lymphocyte ratio and platelet lymphocyte ratio with hypertension.Methods: This cross-sectional study was conducted in 30 hypertensive patients with less than 2 years of duration and in 30 normal healthy adults between ages 40 to 60 years. Anthropometric measurements (height, weight) and blood pressure were measured. Complete blood count was also analyzed. Pearson’s correlation factor (r) was used to analyse quantitative data.Results: Both neutrophil lymphocyte ratio and platelet lymphocyte ratio showed a significant positive correlation with systolic BP observed by Pearson’s correlation. NLR (r=0.847, p<0.001) and PLR (r=0.209, p<0.009).Conclusions: Neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) can be used as reliable parameters in clinical practice and in epidemiological studies as indices of inflammation among hypertensives.
A unique study of post mitral valve surgery status of patients in pre and intra COVID-19 era
Authors: Mukhopadhyay Bhubandeep , Banerjee P.
Published: January 2022

Background: In this study we have studied the change of pulmonary artery pressure after mitral valve replacement and closed mitral commissurotomy. We have also correlated pulmonary artery pressure before and after operation with postoperative outcome.Methods: This study was conducted at Department of CTVS of NRS Medical College and Hospitals from August 2019 to September 2021. All 81 patients had rheumatic mitral valve disease. Among these 73 patients underwent mitral valve replacement (MVR) and 8 patients underwent closed mitral commissurotomy (CMC). Group 1 (n=35) consisted of patients who underwent MVR having preoperative systolic PAP measured by TTE was less than 50 mmHg. Group 2 patients (n=38) had preoperative systolic PAP more than or equal to 50 mmHg measured by TTE. Group 3 patients (n=8), consists of patients who underwent CMC. Compared the results between group 1 and 2 and documented the results of group 3 separately.Results: Our results showed a significant decrease in SPAP after MVR, and further fall of SPAP in the immediate and late postoperative period.Conclusions: In conclusion, PAP returns to near-normal values after MVR in patients with severe preoperative PAH and to normal values in patients with mild preoperative PAH. Reductions in PAP in patients with preoperative PAH occur immediately after MVR.  Postoperative period of patients with severe PAH may be hectic. CMC may be a valid option in isolated MS in selected patients and is very much cost-effective. There were no differences noted among the types of valves used.
Prevalence of fatty liver disease in children with obesity- a diagnostic study based on its ultrasound appearance
Authors: S. Ajitha J. , S. Bindu G. , Sadhakkathulla K. Mohamed , G. Unnikrishnan
Published: January 2022

Background: Non-alcoholic fatty liver disease is an asymptomatic involvement of the liver, can progress to chronic liver disease and must be identified at an early stage for good prognosis. The implementation of the appropriate therapeutic interventions is determinant of the attempts to treat it. For that purpose, early diagnosis and staging of the disease is essential. It seems that diagnostic imaging should be a first-line tool for the staging and monitoring pediatric NAFLD/NASH for appropriate interventions to be implanted in a timely way. This study evaluated the prevalence of fatty liver in relation with body mass index (BMI) by means of ultrasound in children of age group 6-15 years.Methods: In this cross-sectional study, 83 children aged 6 to 15 years, were selected randomly. The participants were examined by a pediatrician. Liver ultrasound was performed for all children and grade of fatty liver was determined.Results: There was a significant correlation between grade of fatty liver with BMI, our study showed a strong association between BMI and prevalence of fatty liver on ultrasound.Conclusions: According to the study hypothesis, based on BMI, the degree of NAFLD in children were predictable. Ultrasound of liver in grading of fatty liver is one of the assessments methods of fatty liver but it is not a diagnostic method; it is useful for prevention to reduce BMI.
Clinicohistopathological study and expression of CK7 and CK20 in mucinous tumors of gastrointestinal tract and ovary
Authors: Killana Santhosh Rupa , Uma Prasad , Lakshmi Atla Bhagya , Laxmi Trivedi Uttapalla , Hari Chandan Kumar Juthuga , Arjuna Gera
Published: January 2022

Background: Mucinous ovarian tumors differ from other types of epithelial ovarian cancers in their clinical behaviour and the need for innovative treatment approaches to achieve improved patient outcomes. Immunohistochemistry plays an important role in diagnosis and differentiates primary and secondary mucinous tumors. To know the distribution and expression of CK7 and CK20 in mucinous tumors of ovary and gastrointestinal tract.Methods: Ninety eight cases of mucinous tumors of ovary and gastrointestinal tract were analysed as per standard protocol out of which malignant mucinous tumors constituted forty five cases. All 45 cases of mucinous carcinoma of ovary and gastrointestinal tract were subjected to IHC CK7 and CK20. The results were analysed.Results: Total mucinous tumors of ovary were 64 cases and total mucinous tumors of gastrointestinal tract were 34 cases. Predominant expression in primary mucinous carcinoma of ovary was CK7 positive and CK20 positive, in metastatic mucinous ovarian carcinoma of gastric origin was CK7 positive and CK20 positive and from colorectal origin was CK7 negative and CK20 positive. Signet ring cell carcinoma of stomach showed CK7 diffuse positivity with focal CK20 positivity. Colorectal mucinous carcinoma was CK7 negative and CK20 positive. The expression varied with the stage of the disease.Conclusions: CK7 and CK20 plays an important role in differentiating primary mucinous carcinoma of ovary from metastatic ovarian carcinoma arising from lower gastrointestinal tract.CK7 and CK 20 expression is variable with stage of disease hence should be interpreted in the background of histopathology.
Effect of phacoemulsification on intraocular pressure, inflammatory changes and visual acuity in cataract patients
Authors: Usharani Laishram , Debnath Subhankar , . Lipokyanger , Meitei Yumnam Chingsuingamba
Published: January 2022

Background: Cataract is the leading cause of blindness worldwide. Even in India cataract is the most significant cause of bilateral blindness. For cataract extraction, phacoemulsification is the most commonly done surgery. This study aims to identify the effect of phacoemulsification in terms of intraocular pressure, inflammatory changes and visual acuity.Methods: A cohort study was conducted in the Department of Ophthalmology, RIMS, Imphal from September 2017 to August 2019 among 218 patients who underwent phacoemulsification surgery. Post-operative examination of visual acuity with snellen visual acuity chart, slit lamp biomicroscopy for anterior chamber reaction and non contact tonometry for measuring IOP was done on day 1, 3, 7, 30 and 90 respectively.Results: Majority (41.3%) of the patients belonged to the age group of 61-80 years. Females (53.70%) were affected more than the males (46.30%). There was a significant improvement of visual acuity following phacoemulsification with 73.9% patient achieving a vision of 6/6-6/18 on day 1 and 100% achieving best corrected visual acuity of 6/6-6/18 at the end of 1 month. Majority of the patients (71.1%) had grade 1 cells in anterior chamber on day 1.By the end of one week only 11.5% had grade 1 cells and no cells were seen by the end of one month. There was a significant (p<0.001) decrease in IOP on different postoperative days.Conclusions: We observed that there was a significant improvement in the visual acuity following phacoemulsification surgery which was comparable to the World Health Organization’s recommendations. Majority had mild anterior chamber reaction which was subsided consequently. Also, there was a significant decrease of IOP post surgery.
F-wave records with submaximal stimulation: sustainability of the data and subject discomfort levels
Authors: Gupta Sangeeta , Singh Ramji
Published: January 2022

Background: F-wave studies are valuable electrodiagnostic tests with considerable roles in early diagnosis of diabetic neuropathy, detection of axonal neuropathies and focal proximal nerve dysfunctions. The recording of F-waves, however, requires recurrent supramaximal stimulation which entails subjects’ discomfort during the procedure. The present study hence attempted to assess the validity of the F-wave data obtained after submaximal stimulation thereby lessening the subject discomfort levels.Methods: The study was conducted on 64 healthy subjects in the age-group of 18-40 years with normal neurological examinations. F responses from median, ulnar, tibial and peroneal nerves by both supramaximal and submaximal stimulation were recorded. Subjects rated discomfort level on a visual analogue scale. Mean values of F-wave minimum latency, mean latency, mean duration, persistence, chronodispersion, F/M amplitude ratio and subject’s discomfort level obtained by the two techniques were compared by paired t-test. P value <0.05 was considered as statistically significant.Results: Mean values of F-wave mean latency, minimum latency, chronodispersion and stimulus duration were not found to be statistically significantly different in the groups (p>0.05). Mean persistence, mean F/M amplitude ratio and mean subject discomfort levels varied statistically significantly.Conclusions: F-wave data can be attained by submaximal stimulation. F-wave mean and minimum latency, chronodispersion and duration remain relatively stable, but more stimuli may be needed for accurate values. For F/M amplitude ratio and F-wave persistence, submaximal reference range would be required. Nonetheless, diminution in subject discomfort with valid F-wave latency values, favours low intensity stimulation.
Moral dilemma: is there a moral difference between killing and letting die in healthcare?
Authors: Alanazi Mansour M. , Alanazi Mohammed R.
Published: January 2022

The purpose of this paper was to prove that there was no moral difference between killing and letting one die in healthcare. It was important to be aware of the moral equivalence of killing and letting die. The Abrahamic religions; Islam, Christianity and Judaism, all argue for the sanctity of life. The world’s major religions Islam, Christianity and Judaism all have doctrines concerning the sanctity of life and they support the main arguments of this paper that there is no moral difference between killing and letting die. In relation to patient autonomy and the patient's right to die, it is very important to highlight that doctors have a moral and legal responsibility to save lives. In addition, we discussed the distinction centres on the true definition of patient autonomy and who was responsible for defining the quality of life. The intention and foresight were critical points that supported the thesis statement that killing and letting one die were one in the same. The acts and omissions doctrine as described in this paper showed that there were no moral difference to kill a person or to let him die. Finally, we extensively discussed the various viewpoints regarding whether or not there was a moral difference between killing and letting die. There is no doubt that the debate over killing and letting die will continue for years to come. It is critical that the issue be addressed at this particular time in history with the advent of modern medical technology.
Vertigo following cochlear implantation: a review
Authors: Swain Santosh Kumar
Published: January 2022

Cochlear implantation may cause a detrimental effect on vestibular function and residual hearing. A significant number of patients with a cochlear implant present with vertigo. There are several mechanisms for dizziness following cochlear implantations. The causes may be surgical trauma, disruption of normal cochlear physiology, or ensuing endolymphatic hydrops. Vibratory trauma affecting the cochlea during cochleostomy plays a vital role in causing paroxysmal vertigo in patients with a cochlear implant. In addition, the vibrations affecting the cochlea are enough to dislodge otoconia particles. During cochlear implantation, it is necessary to insert an electrode array into the cochlea and thus the chance of damage to cochlear and function may happen. Dizziness or vertigo may develop after cochlear implantation. It usually occurs due to vestibular hypofunction. Vertigo following cochlear implantation has not frequently been documented in the literature previously. However, the increasing number of cochlear implantations in the current scenario is showing different postoperative complications like vestibular symptoms among patients with an implant. The vestibular symptoms following cochlear implantation range from a gradual sense of mild unsteadiness or lightheadedness to brief attacks of whirling vertigo. Vertigo following cochlear implantations affects the quality of life although vestibular therapy is often helpful to manage this condition. The article aims to provide a comprehensive review of vertigo following cochlear implantation.
S-100B in the follow-up of patients with stage III and IV melanoma: pursuit of the Holy Grail
Authors: Ackermans L. L. G. C. , Aldenhoven L. , Bosmans J. W. A. M. , Van Kuijk S. M. J. , Van Bastelaar J.
Published: January 2022

Background: Patients with stage III-IV melanoma are at considerable risk for disease recurrence. Early detection of recurrence is important to optimize immunotherapy administration and improving progression-free and overall survival. S-100B can be used as tumor marker to evaluate whether patients are at risk for developing disease recurrence or progression. It could be a promising tool to determine whether patients need to receive additional diagnostic procedures. However, implementation in routine clinical setting is limited. Hence, this study aimed to evaluate the value of S-100B as a decision tool for the need to perform an 18F-fluorodeoxyglucose (FDG) positron emission tomography with computed tomography (PET/CT) to confirm disease recurrence or progression in stage III-IV melanoma patients.Methods: Data of 51 stage III-IV melanoma patients, presenting for follow-up after surgery with curative intent, was retrospectively extracted from a single-center electronic patient record system. 18FDG-PET/CT was performed based on clinical signs or elevated S-100B levels. S-100B measurements were treated as independent data points.Results: Fifteen out of 303 S-100B levels were elevated. Six elevated levels were causes by disease progression; 4/6 measurements were noted with concurrent clinical signs. Twenty-four events of disease progression were confirmed. The sensitivity and specificity of S-100B serum test were 25.0% [95% CI (9.8-46.7)] and 96.8% [95% CI (94.0-98.5)]. The positive predictive value (PPV) and negative predictive value (NPV) of S-100B were 40.0% [95% CI (20.6-63.2)] and 93.8% [95% CI (92.2-95.0)].Conclusions: Elevated S-100B levels did not exclude nor indicate metastatic or recurrent disease in this study. Using S-100B in routine clinical setting does not seem to be of additional value.
Comparison of short-term outcomes between multi-port and single-port sleeve gastrectomy: a prospective study
Authors: Alkashty Mohamed Eid , Bakr Ashraf A. , Nashed George A. , Fahmy Mohamed H. , Elward Athar S.
Published: January 2022

Background: Single-incision laparoscopic surgery has attracted a great deal of interest in the surgical community in recent years, including bariatric surgery. Literature is scarce about operative and clinical outcomes of single port sleeve gastrectomy (SPSG) compared to conventional laparoscopy. SPSG has been proposed as an alternative to the multiport laparoscopic procedure; however, it has yet to meet wide acceptance and application.Methods: This was a prospective non-randomized clinical study, to evaluate the feasibility and short-term outcomes of SPSG in comparison to the conventional multiport sleeve gastrectomy (MPSG).Results: Weight loss, resolution of comorbidities, length of hospital stay, complications were almost comparable in both groups. Operating times were longer in SPSG group. Two patients only required re-laparoscopy, one in either group. There were no leakage or mortalities. Patients in the SPSG group had better wound satisfaction and less post-operative pain.Conclusions: SPSG is a safe, effective, and feasible surgical procedure for morbid obesity in selected individuals and comparable to the conventional laparoscopic technique in terms of outcomes. It has equally effective weight loss and resolution of comorbidities. It also has the added benefits of little/ no visible scarring and reduced postoperative pain.
Role of valproic acid and allopurinol in neuroprotection after cardiac surgery on Bangladeshi patients
Authors: Khan Omar Sadeque , Hoque Rezwannul , Rahman Mostafizur , Imtiaz Nasif
Published: January 2022

Background: Neurological complications are very much common after cardiac surgery in postoperative setting in Bangladesh. However, we are dealing these complications in our day-to-day practice and it costs money, longer hospital stays and admissions to rehabilitation facilities. The aim of the study was to evaluate the effectiveness of sodium valproic acid and allopurinol in preventing neurological injury following cardiac surgery with cardiopulmonary bypass.Methods: This cross-sectional study was conducted by the department of cardiac surgery, Bangabandhu Sheikh Mujib medical university (BSMMU), Dhaka, Bangladesh from January 2019 to June 2021. Total 70 patients were included and divided into two groups (36 patients with sodium valproic acid and allopurinol in group A and 34 patients without sodium valproic acid and allopurinol in group B). 10 patients were dropped out. As these two drugs were FDA approved was used per-orally for 5 perioperative days (2 days prior surgery, 1 day in operation day, 2 days postoperatively). Collected data were entered, checked and edited (to remove the outliers) with the help of the statistical package for social sciences (SPSS) software, version 26 and analyzed.Results: The intervention group (group A) had maximum survival rate (no mortality) less ICU stay, less hospital stay, early intubation, no neurological injury (p<0.05). On the contrary group B (no intervention) had 6 mortalities, several mild to moderate neurological injury, more ICU and hospital stay and morbidity.Conclusions: Sodium valproic acid and allopurinol gives neuroprotection in on-pump cardiac surgical patients. So, these two medicines can be prescribed prophylactically on individual basis.
Results of surgical treatment of distal humerus fractures in adults in Cotonou
Authors: Chigblo S. Pascal , Gbessi Gaspard D. , Amossou Francois , Padonou Adebola , Tidjani Fiacre I. , Lawson Eric , Goukodadja Oswald , Akue Aristote H.
Published: January 2022

Background: Fractures of the distal humerus represent 1.3% of fractures in Cotonou. Their treatment is often surgical. The aim of this work was to assess the results of their osteosynthesis in a disadvantaged environment.Methods: This retrospective study from 2001 to 2015 included 38 operated patients for distal humerus fracture with a minimum follow-up of 12 months. The average age was 33.6 years; the predominance was male (27 cases). The major etiology was traffic accidents (31 cases), According to the AO classification, the fractures were type A (10 cases), type B (02 cases) and type C (26 cases). The average time of surgery was 21 days. The Lecestre plate was the most used (29 cases). An iliac cortico-cancellous graft was used in 03 cases. The mean hospital stay was 20 days.Results: The mean follow-up was 37 months. Functionally, the mean Mayo elbow performance score (MEPS) score was 66.3 points. The results were excellent (08 cases), good (13 cases), average (10 cases) and bad (7 cases). The patients were satisfied or very satisfied in 29 cases. Radiographically, the reduction was anatomical in 34 cases. Anatomical reductions were obtained with Lecestre plates. Consolidation was achieved in 36 cases within an average of 9 weeks. As complications we noted: radial nerve paresis (03 cases); secondary displacement (02 cases); superficial infection of the operating site (02 cases), wire migration or screw retraction (05 cases), non-union (03 cases), malunion in varus (04 cases) and osteitis of the proximal ulna (01 case).Conclusions: Fractures of the distal humerus are infrequent. The anatomical and functional results despite little technical support provided and the long delay before surgery are quite good.
Management of anorectal reverse sinus diseases
Authors: Singh Mahendra Pal
Published: January 2022

Background: It is usual to face complexities in perianal abscesses, fistulas and perianal sinus diseases. Perianal sinus indicates to a blind tract in the perianal area with a discharging opening externally. We selected patients with perianal blind tracts with intra-luminal discharging openings (Reverse sinus) without any visible external opening. Treatment policy was altered accordingly.Methods: We excluded sinuses with external discharging openings, fistulas, hemorrhoids, simple fissures and malignant pathologies. Study was conducted in 64 patients at city hospital, sector-8 Chandigarh. Ours is a hospital based descriptive study conducted between January 2020 to June 2021.Results: Patients with reverse sinuses were divided into four groups based on their etiology. Chronic fissures with discharging opening at 6o clock position (18 cases). Primary anorectal abscesses with intraluminal opening and without any external opening (14 cases). Primary operated anorectal abscess with reverse sinus and no external opening (20 cases). Patients having previous fistula surgery presenting with reverse sinus (12 cases). Treatment in general was tricky yet local healing and long-term results were very good.Conclusions: Once the internal opening is located retrograde probing was done. Perianal nick-incision over the tip of the probe helped to convert sinus into fistula. Subsequent fistulotomy was performed. In case of thick Sphincteric chunk loose seton was encircled around the sphincteric muscle. Subsequently the seton was tightened to achieve cutting and healing simultaneously. In cases of failed retrograde probing perianal nick-incision was given to perform usual probing of the fistula made.
Treatment of cystic swelling of scrotum: a clinical analysis
Authors: Charpot Rahul , Modi Kunal
Published: January 2022

Background: Cystic swellings of scrotum are usually painless and can attain a very big size without causing much discomfort. Management of cystic swelling of a particular type can be done in various ways; hence there is a necessity to study the ideal modality of management for each type of cystic swelling of scrotum possible in our setup of rural hospital.Methods: A total of 100 cases of cystic swellings of scrotum fulfilling the methodology criteria’s were subjected to preformatted study. Final diagnosis was made with clinical examination and ultrasonography of scrotum. All cases were treated surgically.Results: Most of the patients were in age group of 51-60 years (30%), presenting feature being scrotal swelling as a main complaint in 86% of cases, majority of them were right sided (60%), primary vaginal hydrocele was the commonest cystic swelling (76%), followed by epididymal cyst, spermatocele, sebaceous cyst. Lord’s plication was the procedure, which was associated with early discharge of the patient and least post-operative complications.Conclusions: Primary vaginal hydrocoele was the commonest cystic swellings of scrotum. Most of the cystic swellings were treated surgically with good results. Lord’s procedure was the least to have post-operative complication.
Retrospective analysis of etiological factors and clinical presentation of pancreatitis in patients of a tertiary care hospital
Authors: Mandalapu Srinivas Rao , Kishore. G Krishna
Published: January 2022

Background: Acute pancreatitis is a complicated illness with a wide range of local and systemic consequences that surgeons throughout the world deal with. This study evaluated the etiology and clinical presentation of acute pancreatitis patients retrospectively in a tertiary health care center.Methods: This study is a cross-sectional, retrospective hospital-based study that was conducted from Feb 2012 to Feb 2020 which was conducted on 500 patients who had acute pancreatitis in the department of general surgery and gastroenterology in a tertiary health care center.Results: Out of the total of 500 patients, 75% of males had acute pancreatitis and 25% of females had acute pancreatitis. The 52% of the patients had epigastric pain without radiating to the back and it was the most common clinical presentation followed by 30% of the patients had epigastric pain radiating to the back followed by generalized abdominal pain (18%). Nausea and vomiting were observed in most of the cases (71%). Alcohol-induced pancreatitis was the most common (41.2%) among the 500 cases, followed by idiopathic pancreatitis (36.2%). The acute fluid collection was identified in 26.6% of cases. The most prevalent systemic consequence was respiratory system involvement (15%).Conclusions: The most common clinical manifestation was epigastric pain with no radiation to the back. In our study, the incidence of alcoholic pancreatitis (41.2%) and idiopathic pancreatitis (36.2%) was slightly greater, prompting us to look for additional aetiologies in the idiopathic category in future investigations.
Outcome of retrograde intrarenal surgery in the management of urolithiasis in a tertiary care centre in North India
Authors: Sharma Ankitkumar , Dhar Tanisha
Published: January 2022

Background: Nephrolithiasis is the most common presenting pathology to the urology clinic. Retrograde intrarenal surgery (RIRS) has made the treatment of upper ureteral and renal calculi a relatively atraumatic affair. We undertook a study to analyse the outcomes of RIRS performed at our institute.Methods: All patients undergoing RIRS at Government Medical College and Associated Hospitals, Jammu from November 2015 to October 2016 were included in the study population and the data prospectively collected. Patients were followed up till 6 months.Results: 62 patients underwent the procedure during the study period. Majority of the patients were of the younger age group with 56.45% patients being females. 41.9% (n=26) patients had ureteric calculi which were pushed back while 12.9% (n=8) patients had concurrent ureteral and renal calculi. One patient had a malrotated kidney with calculus, which could be cleared. The median stone size was 12 mm (range 7-18 mm). 87% were stone free at the end of the procedure. 6% procedures had to be abandoned, and 6% patients underwent follow on extracorporeal shock wave lithotripsy (ESWL). The overall stone free rate was 93.54%. The mean post-operative pain score was 2.8. Five patients developed post-operative pyelonephritis and none developed ureteric injury, avulsion or collection. At 6 months, no patient had stone recurrence or hydronephrosis.Conclusions: RIRS is a relatively safe procedure with good stone clearance. Minimal post-operative pain, with >90% stone clearance make it the cornerstone in the management of renal calculi. Our study shows that RIRS can be safely performed with minimal long term complications.