bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinico-pathological study of oesophageal cancer: a 3 years retrospective and 1½ year’s prospective analysis
Authors: Suryawanshi Shrikant S. , Chenkula Saia , Zohmingthanga John , Ralte Zothansanga
Published: September 2021

Background: In India, oesophageal cancer is second most common cancer among males and fourth most common among females and is associated with certain diets and lifestyle. In India, the age-adjusted incidence rates for oesophageal cancer are the highest in men (25.5) and women (5.5) in Mizoram. Aim of the study was to find the clinical and histopathological findings of oesophageal cancer patients at Civil Hospital, Aizawl.Methods: A descriptive study (3 years retrospective and 1½ years prospective) was conducted at Civil Hospital, Aizawl, Mizoram from July 2013 to December 2014 (1½ years) amongst 104 patients reporting to Civil Hospital, Aizawl for oesophageal cancer.Results: History of progressive dysphagia to solids was most common symptom and observed in 91.3% patients. Histopathological examination of resected esophageal specimen showed 95.7% patients were detected with squamous cell carcinoma, 4.3% patients were detected with no proper malignancy/residual tumor.Conclusion: Squamous-cell carcinoma was the most common type of esophageal cancer occurring in the middle third of the oesophagus with as observed on upper gastrointestinal (GI) endoscopy. More men were affected than female.
Retrospective analysis of donor deferral for plateletpheresis at a regional transfusion center, in North-West India
Authors: Pal Ashok , Bundas Sunita , Handa Anjali
Published: September 2021

Background: Single donor platelet (SDP) is one of the valuable component for thrombocytopenic patients for obtaining good post transfusion count increment, good yield of product is required. Proper donor selection has a crucial role in in safety and quality of product therefore proper screening of donor is mandatory. The aim was to find out reasons and frequency of plateletpheresis donor deferral and to encourage safety of donor for recruitment of new SDP donors.Methods: A retrospective analysis of data was done over a period of 1 year from June 2018 to May 2019 from the data centre of the institute.Results: Out of 1365 donors, 1200 were selected for plateletpheresis procedure and remaining 165 donors were deferred for various reasons. The predominant age of donors ranges from 25-35 years. Among the deferred donors temporary donors accounted for 93.33% and permanently deferred donors were 6.61. Most common cause for deferral were poor venous access 52 (31.51%). Low platelet counts 32 (19.39), low Hb 26 (15.75%), underweight 24 (14.54%), under medication 9 (5.45%), alcohol intake within 24 hours 6 (3.63%) and others like tattoos, infections/inflammations at phlebotomy sites 5 (3.03%) and most common reason for permanent deferral were sero-positivity for HbsAg 6 (3.63%), chronic diseases 4 (2.42%) (cardiovascular diseases bronchial asthma), others 1 (0.6%).Conclusions: For obtaining good yield of product, proper donor screening is required. Temporary deferred donors should be counselled properly and encouraged for further donation when comes under selection criteria. Donor selection criteria for apheresis may be revised.
Sleep quality, mental health and body mass index among undergraduate medical students: a cross-sectional study
Authors: Kharche Piyush , Patle Rupali A.
Published: September 2021

Background: Association of sleep disorders is found cardiovascular mortality, stroke, diabetes, impaired glucose tolerance, immune dysfunction, endocrine impairments, and psychiatric morbidities including depression. Sleep quality affects college students physical and psychological health. Thus, poor sleep quality is a serious problem in college students. This study was done to assess the quality of sleep among undergraduate medical college students, to explore relationship between quality of sleep and body mass index, to study relationship between quality of sleep and anxiety, to study relationship between quality of sleep and depression.Methods: Total 300 medical students were selected by systematic random sampling method i.e. 25 students from each year studying in 3 government medical college were selected. A descriptive questionnaire for all socio-demographic parameters along with validated instrument i.e. for sleep quality, Pittsburgh sleep quality index (PSQI), for anxiety Hamilton anxiety rating scale and for depression, Becks depression inventory were used for the data collection instruments.Results: Amongst the 300 subjects 189 (63.00%) were found to be poor sleepers. The sleep quality was poor among the subjects who are in final academic year though the difference was not statistically significant (c²=2.78, df=3, p=0.4267). It was found that sleep quality was decreased among overweight and obese persons, but the difference was not statistically significant. (c²=4.657, df=2, p=0.0974). Prevalence of anxiety was found to be more in poor sleepers. Depression was also more common among the poor sleepers and the difference was statistically significant.Conclusions: Poor sleep quality was associated with depression and anxiety in students.
A cross sectional study to assess the prevalence and risk factors of post-partum depression in urban area of Indore district
Authors: Bhaskar Priyanka , Yesikar Veena , Bansal S. B. , Waskel Bhagwan
Published: September 2021

Background: Pregnancy and childbirth are important events in the life of a woman. Life with the new born can be very rewarding but it can be very tough for some women. This phase of life brings about many hormonals, physical and emotional changes in the women during childbirth. Aims and objectives were to find out the prevalence and risk factors of post-partum depression (PPD) in urban area of Indore district and to assess the socio demographic profile of study populationMethods: The study was a cross sectional community-based study, conducted on women who had delivered within a period of 6 weeks to 3 months. 100 women from urban area were selected from Indore district through simple random sampling. Informed consent in written was taken from the mothers. The study tool was pre designed semi structured questionnaire and Edinburgh post-natal depression scale (EPDS) scale, data were entered in excel sheet and analyzed using SPSS software, appropriate statistical test were applied wherever necessary.Results: In our study it was found that prevalence of PPD in urban Indore was 23%. We found that age at the time of marriage below 18 years, mode of delivery (LSCS), initiation of breast feeding (after 1 hour) and birth weight of baby less than 2.5 kg had a strong association with PPD. In our study 58% had normal vaginal delivery and 42% had LSCS in urban area. In urban areas 36% gave a history of birth weight of babies <2.5 kg.Conclusions: Symptoms of PPD were significantly high in urban Indore mothers and they were strongly associated with risk factors.
A questionnaire-based study to assess the knowledge, attitude and behaviour about leprosy among paramedical staff in a tertiary care hospital in Chennai
Authors: Manoharan D. , Kulkarni Ojas Dipak , C. Geo Danny , Manoharan K.
Published: September 2021

Background: The paramedical staff has an important part in the management of leprosy patients. They have a role in counselling, wound management, performing investigations etc. This study aimed at assessing the knowledge, attitude and behaviour of paramedical workers in a tertiary care hospital in Chennai.Methods: This cross-sectional study comprised of 100 paramedical workers of which 41 were males and 59 were females. Following classes of workers were included: nursing staff, auxiliary nursing midwives, ASHA workers, laboratory technicians, pharmacists and allied medical workers. Of these, the nursing staff comprised of the highest proportion (44%). The paramedical workers were given a questionnaire consisting of their demographic profile and further 32 questions to assess knowledge, attitude and behaviour towards leprosy. The data hence obtained over a period of 1 month was later systematically analysed.Results: The knowledge of paramedical workers was considered sufficient in the nursing staff, ANM and ASHA workers. It was consistently found that those workers who had some experience in the field of leprosy (39%) showed good level of knowledge, while others had a scope for improvement. The paramedical workers’ attitudes and behaviour were deemed to be overall appropriate, while there is a clear need to improve outreach initiatives in order to properly train them.Conclusions: The training of paramedical workers in leprosy should be prioritised. They are the initial point of contact for patients. There should be a greater emphasis on raising awareness and providing accurate information about the disease.
Gender based differences in lipid profile and other novel atherogenic risk factors in type-2 diabetes mellitus patients
Authors: Jaidev Arpita , Shah Hitesh , Chaturvedi Mayank K.
Published: September 2021

Background: Utilization of lipids and lipoproteins gets altered in diabetes mellitus (DM) leading to atherogenic dyslipidemia. This study evaluates cardiovascular risk profile of diabetic men and women, including conventional lipid profile and novel risk factors namely lipid ratios, atherogenic coefficient and atherogenic index.Methods: In all 200 diabetic patients (100 males and 100 females) aged 18-65 years who were under treatment were randomly sampled for the study. Socio-demographic data were collected. Glycated hemoglobin levels, lipid profile, fasting blood sugar, were estimated using standard procedures. Anthropometric variables such body mass index (BMI) was measured, systolic and diastolic blood pressures were also taken. There was no difference between men and women with respect to duration of DM and type of treatment.Results: Lipid profile estimates showed that diabetic females had higher level of total cholesterol (TC) (198.07 vs 169.5 mg/dl) and higher level of high-density lipoprotein (HDL)-C (43.99 vs. 41 mg/dl) as compared to males. All the parameters that are raised total cholesterol, triglyceride levels and low-density lipoprotein (LDL) levels were observed in significantly higher proportion of females as compared to males. The values of atherogenic indices [CR1, CR2, AC and atherogenic index of plasma (AIP)] for both genders were higher than the baseline value. In this study females had higher mean non-HDL 154 mg/dl as compared to males mean non-HDL 129 mg/dl and this study showed that female participants held on in high-risk AIP category and so they were at a higher risk of developing coronary heart condition.Conclusions: Dyslipidemia was observed in a greater proportion of female diabetic patients than male diabetic patients.
Alcohol state markers- facility and utility for clinical management of alcohol use disorders: study from a tertiary care centre in South India
Authors: J. Liji M. , Varghese P. R. , Innah Susheela Jacob , Kuttichira Praveenlal
Published: September 2021

Background: Alcoholism is broadly any drinking of alcohol resulting in significant psychological and physiological health problems. As alcoholism is not a recognized diagnostic entity the detection and monitoring of the clinical manifestations of alcoholism is of great importance in the alcohol use disorders (AUD) treatment. Hence, the use of alcohol biomarkers plays a vital role in the diagnosis, treatment and prognosis of AUDs.Methods: This study aimed to understand the utility of state markers in alcohol related distress, both for diagnosis and prognosis in a tertiary care centre. The relative number and the frequency of the alcohol biomarker tests such as AST (aspartate aminotransferase), ALT (alanine aminotransferase), MCV (mean corpuscular volume) and GGT (gamma-glutamyl transferase) investigated in the hospital departments (32 departments) were collected. Test requests and results in January to March on five consecutive years from 2016 to 2020 were analyzed, by comparing psychiatry department with all other departments and AUD with non-AUD cases.Results: The study findings revealed that, the tests AST, ALT and MCV were well utilized for the AUD treatment procedure in the tertiary care centre, irrespective of the department the patient got admitted. Since GGT was the least preferred test, the figures of GGT could not be analysed because of the exceptionally low number.Conclusions: The utility of the commonly available alcohol biomarker tests is especially useful for the clinical management of AUD patients and these are well utilized in an appreciable manner in the study centre. Development of more accurate, specific, and sensitive panel of biomarker tests may further motivate clinicians to better monitor individuals who suffer from alcoholism.
Immature teratoma with a rare finding of choroid plexus
Authors: Kashyap Mehak , Gupta Neelam , Dubey Vikas , Kaur Nechal
Published: September 2021

Mature cystic teratoma of the ovary is the most common ovarian tumour in young women. Immature teratoma is a very rare tumour, representing only 1% of all ovarian cancers. Paediatric ovarian tumours are rare, with a reported incidence rate of 2.2/100,000 in girls aged 0 to 15 years. In the case report presented here, was 12-year-old suspected to have serous cystadenoma of ovary based on CT scan, which was ultimately diagnosed with immature teratoma grade 3 after histopathological examination was done.
Limited palmar fasciectomy for bilateral Dupuytren’s contracture
Authors: Rao Venkata Mahipathy Surya Rao , Durairaj Alagar Raja , Sundaramurthy Narayanamurthy , Jayachandiran Anand Prasath , Rajendran Suresh
Published: September 2021

Dupuytren’s disease is a fibro-proliferative condition affecting the palmar and digital fascia. This disease is very common in Northern Europe but in India it uncommon as there are only a few cases reported, hence also called as ‘Viking Disease’. Surgical fasciectomy is the standard surgical treatment of choice for Dupuytren’s disease. Complications following surgery are high but there is no definitive cure for Dupuytren disease (DD), and recurrence of finger contractures after treatment is common.
Early onset type 1 diabetes mellitus in an infant during COVID-19 pandemic: case report
Authors: Astiti Made Yuliantari Dwi , Pramana Putu Harrista Indra , Suryawan I. Wayan Bikin
Published: September 2021

Type 1 diabetes mellitus (T1DM) is an endocrine disorder, marked by elevated blood glucose level caused by autoimmune process destroying the β-cells of the pancreas which mostly affects children. It is an often-overlooked condition, with low awareness among clinicians and parents alike which led to late diagnosis and patients often presenting with acute complications. Often triggered by a viral infection, here we presented an interesting case of early onset T1DM presenting with Diabetic ketoacidosis (DKA) during a COVID-19 pandemic. A female infant, aged 1 years and 2 days old, presented with dyspnea and fever. Physical examination was otherwise normal, without any rhonchi or wheezing found during pulmonary auscultation. Nasopharyngeal swab and SARS-CoV-2 antigen test was found negative. Laboratory workup found random blood glucose level of 577 mg/dl accompanied by acidosis and ketonuria. The patient also had elevated white blood cells and platelet counts. She was admitted for treatment in the Pediatric intensive care unit (PICU) with therapeutic regiments consisting of slow intravenous insulin infusion, potassium chloride intravenous fluid, antibiotics, and antipyretics. Close monitoring of blood glucose ensues and the patient was treated for 5 days followed by outpatient therapy with mixed insulin treatment twice per day. This case was interesting as T1DM usually manifested in older children with median age of diagnosis ranging from 8 to 13 years old, depending on population. T1DM diagnosed in children younger than 6 years old are classified early onset and it is especially rare to found in infants. Although the patient tested negative for SARS-CoV-2 antigen, the onset of the case coincides with a recent surge of cases locally. It meant that we cannot rule out possibility of prior unknown exposure or infection which may precipitate the condition.
Management of a case of thromboembolism post spine surgery: a case report
Authors: Tomer Manoj K. S. , Shah Kalpana , Bhojraj Shilpa , Devi Pinki
Published: September 2021

Postoperative deep vein thrombosis (DVT) of lower limbs is often asymptomatic. In many patients, fatal pulmonary embolism (PE) is the first clinical manifestation of postoperative venous thromboembolism (VTE). Routine screening for asymptomatic DVT of the lower limbs has a low sensitivity and is quite impractical. For these reasons, routine and systematic prophylaxis in patients at risk, is the strategy of choice to reduce the burden of VTE after surgery. If used appropriately such prophylaxis is cost effective since it reduces the incidence of symptomatic thromboembolic events, which require costly diagnostic procedures and prolonged anticoagulation therapy. Here we report the post-operative course of a spine surgery patient, presenting with DVT in calf veins, which lodged into pulmonary artery and was managed successfully with low molecular weight heparin (LMWH), embolectomy, inferior vena cava (IVC) filter, and dabigatran.
Encapsulated cyst fat necrosis masquerading as cold abscess
Authors: Kashyap Mehak , Gupta Neelam , Dubey Vikas , Kaur Nechal
Published: September 2021

Encapsulated fat necrosis is a benign, usually asymptomatic and underreported condition. It is believed to be trauma‐related ischemia and necrosis of fat tissue that gradually detaches from its surroundings. Here we reported a case of encapsulated cyst fat necrosis in a 75 years old female following intramuscular injection, who was clinically diagnosed as cold abscess initially.
Current treatment of difficult airway: a practical review of advanced techniques for airway management
Authors: Mendoza-Aceves Rodrigo A. , Ortega-Madrid Enrique , Meade Yovanovich Karen , Bernal Barroeta Brenda , Gómez-Mendoza Francisco Fabián , Banegas-Ruiz Rodrigo , Barrera-Mera Baltazar , Valderrama-Treviño Alan I.
Published: September 2021

The airway by definition is a conduit through which the air passes; or it is the route by which the air travels from the nose or mouth to the lungs. An exhaustive review was performed with the available literature using the PubMed, ScienceDirect, Scopus and Cochrane databases from 2009 to 2021. The search criteria were formulated to identify reports related to difficult airway management. To allow controlled ventilation, the airway must meet two characteristics in priority order, be permeable and airtight. In assessing risk, in addition to looking for predictors of difficult airway, it was important to understand the global clinical circumstances. Faced with a patient with a difficult airway, decision-making must be agile and correct since any decision can modify the clinical outcome.
Pedicled transverse rectus abdominis myocutaneous flap breast reconstruction: Hospital Kuala Lumpur’s early experience
Authors: Anuar Nur A. A. , Awang Raflis R. , Khoo Ee T. , Anthonysamy Daphne , Darail Nor A. H. , Emran Nor A.
Published: September 2021

Background: Breast reconstruction is traditionally performed by the plastic surgeons. In the last four years, we have embarked on autologous breast reconstruction. We conducted a retrospective study to evaluate the complications and cosmetic outcomes of a pedicled transverse rectus abdominis myo-cutaneous (TRAM) flap breast reconstruction.Methods: We enrolled forty-one patients who underwent a TRAM flap reconstructive surgery between January 2016 and January 2020 at the hospital Kuala Lumpur, Malaysia. Thorough retrospective reviews of medical records were performed. Patient’s satisfaction on the cosmetic outcome were assessed with the breast-Q questionnaire.Results: Forty-one patients with a mean age of forty-six years old, had ipsilateral pedicled TRAM breast reconstructions for various breast pathologies including invasive carcinoma (n=31, 75.6%), ductal carcinoma in situ (n=8, 19.5%) and phylloides tumor (n=2, 4.9%). Immediate reconstruction was performed in thirty-nine patients and delayed reconstruction in two patients. Based on The American joint committee on cancer (AJCC) TNM system, the pathologic stages among those patients with breast cancer were 0 (n=8, 20.5%), I (n=3, 7.69%), II (n=9, 23.1%), III (n=18, 46.1%), and IV (n=1, 2.56%). During the mean follow-up of seventeen months, flap and donor site complications were reported in twelve patients (29.3%) and five patients (12.1%) respectively. Nineteen were very satisfied and sixteen were satisfied.Conclusions: Breast reconstruction with a TRAM flap can be safely performed by the oncoplastic breast surgeons with good aesthetic outcomes.
Comparison between the outcome of proximal femoral locking compression plate and dynamic hip screw in intertrochanteric femoral fractures
Authors: Arif Adnan , Bhatti Hamza Waqar , Chaudhary Noman Ahmed , Sadiq Abdullah
Published: September 2021

Background: Inter-trochanteric femoral fractures are associated with a high complication rate and mortality. This study aims to compare the proximal femoral locking compression plate (PFLCP) with dynamic hip screws (DHS) for inter-trochanteric femoral fractures in terms of mean bone union time.Methods: It was a prospective randomized study conducted at the department of orthopedics, Benazir Bhutto Hospital, Rawalpindi, Pakistan from June 2015 to December 2015. Sixty patients with a diagnosis of inter-trochanteric fractures, requiring orthopedic surgery, were included in the study. After randomization thirty patients underwent PFLCP fixation and the other thirty patients underwent DHS fixation. Patient information, demographic data, and functional level were assessed. Mean bone union time and implant complications were compared for the two treatment groups.Results: Patients who underwent PFLCP fixation demonstrated shorter bone union time (2.8±0.2 months) than those who underwent DHS fixation (3.2±0.1 months) (p<0.000). PFLCP group had 90% bone union whereas DHS group had 76.66% bone union at 12 weeks (p=0.16). Conclusions: PFLCP is better than DHS for intertrochanteric femoral fractures in terms of shorter mean bone union time and fewer complications.
A clinical study on prevalence of subclinical hypothyroidism in patients with cholelithiasis in a tertiary care center in South India
Authors: A. Khalilur Rahman , S. Rajesh , Balineni Pradeep
Published: September 2021

Background: Gall stones are the most common biliary pathology. Hypothyroidism has been shown to promote gall stone formation and prevalence of clinical hypothyroidism in patients with cholelithiasis is extensively studied. This study aimed to find the prevalence of subclinical hypothyroidism in patients with cholelithiasis.Methods: A prospective study on 94 patients was carried in Saveetha medical college and hospital, Tamil Nadu, India between March 2017 and June 2019. All patients underwent imaging studies for confirmation of gall stone disease and serum FT3, FT4 and TSH estimation done.Results: Out of 94 patients, 47 patients were between 30-50 years (50%). 30 (31.9%) patients were hypothyroid and 64 (68.1%) were euthyroid. Among the hypothyroid patients, 3 (3.2%) had clinical hypothyroidism and 27 (28.7%) had subclinical hypothyroidism. 80 (85.1%) patients had multiple calculi and 14 (14.9%) of patients had single calculus.Conclusions: Majority of patients were in the age group of 30-50 years with females 53.2% and males 46.8%. Hypothyroidism was diagnosed in nearly one-third of patients in our study with a high prevalence of subclinical hypothyroidism (28.7%). No significant correlation was found with respect to age, gender, number of gall stones to serum TSH levels.
Impact of single dose versus multidose prophylactic antibiotics in elective hernia repair: an institutional study
Authors: Durai Ramula M. , Mohamed Noorul
Published: September 2021

Background: Antibiotics used prophylactically in anticipation of surgery-related infection are not indicated for elective surgical procedures where the chance of infection is very low and the expected benefit of antimicrobial treatment is not well documented. Routine prophylactic use of antibiotics in clean cases and the difficulty in balancing the benefits of the intervention with the potential adverse drug reaction is debatable. There are not much randomized, controlled trials or patient-specific information to assess his balance precisely, but only general guidelines for the clinician to decide for his patients. This study was conducted in our Institute to inquire the basis that prevention of surgery related infection in elective groin hernia repairs equally effective when patients were given either preoperative single-dose or multi-dose antibiotics postoperatively.Methods: This prospective, longitudinal study, 100 eligible patients who were admitted for elective hernioplasty, were randomly assigned in two equal groups with 50 each. Single dose (SD) group was given a single antibiotic of 2 gm parental amoxycillin-clavulanic acid at the time of induction of anesthesia. The multidose group was given through intravenous route same antibiotic (2 gm) preoperatively followed by amoxycillin-clavulanic acid (1 gm) twice a day for two days in their post-operative period also and their effect compared.Results: In the single-dose prophylactic antibiotic group (group I) the surgery related infection rate was only 8%, compared to those who received postoperative multiple-dose groups (group II).Conclusions: The postoperative wound-related infection rate after a single dose antibiotic parenterally at the induction of anesthesia is favorably compared with that of multiple-dose antibiotics.
Long term outcomes following pyeloplasty for unilateral pelviureteric junction obstruction in paediatric patients
Authors: Inugala Anusiri
Published: September 2021

Background: Pelviureteric junction obstruction (PUJO) is the most common cause of pediatric hydronephrosis. The gold standard treatment for PUJO is Anderson hynes (AH) dismembered pyeloplasty. The parameters to assess the post-operative outcomes of pyeloplasty include reduction in the AP diameter of the pelvis and increase in parenchymal thickness. The aim of the study was to find out the long-term outcomes following pyeloplasty for Ureteropelvic junction obstruction (UPJO) in paediatric patients.Methods: A prospective study was done from September, 2014 to January, 2019. All children above the age of 2 months who presented with unilateral PUJO were included in the study. All patients underwent ultrasound of the kidneys and diuretic renogram. All patients underwent AH dismembered pyeloplasty. Success was defined as both symptomatic relief and radiographic resolution of obstruction at the last follow-up visit.Results: 60 patients with unilateral intrinsic PUJO were included in this study. Post-operatively split renal function (SRF) improved in 42 patients, remained stable in 13, and deteriorated in 5 cases. Post-operative renal drainage improved in 40 patients, remained stable in 15 and deteriorated in 5.  The degree of hydronephrosis deteriorated in 5 cases but improved or was preserved in 55 cases. The renal parenchyma deteriorated in 7 cases. Overall success rate of AH dismembered pyeloplasty was 92%.Conclusions: Dismembered pyeloplasty is a safe and effective treatment of PUJO in the pediatric population. Majority of the patients had an improved split renal function, renal drainage, cortical thickness, and decreased degree of hydronephrosis.
A study of correlation of degree of midline shift on computed tomography scan and Glasgow coma scale in patients of acute traumatic head injury
Authors: Chaurasia A. K. , Dhurve Lalit , Gour Rajneesh , Kori Rajpal , Ahmad Avias K.
Published: September 2021

Background: Traumatic brain injury is one of most common cause of death in road traffic accident. Most of these classified as mild injury, with approximately 20% classified as moderate to severe. Approximate 50% of the 150,000 trauma deaths every year are caused by head injury.Methods: A prospective cross-sectional study was conducted on 150 patients with a head injury admitted in the Hamidia hospital, Bhopal. The assessment of the severity of head injury using Glasgow coma scale (GCS) at the time of admission, follow up on 5 days and 15 days respectively. The collected data were transformed into variables, coded and entered in Microsoft excel. Data were analyzed and statistically evaluated using statistical package for the social sciences (SPSS)-PC-21 version.Results: Out of 150, a total of 115 patients had no midline shift while 35 patients were having midline shift. Severe head injury patients (GCS 3-8) were having more morbidity and mortality. Moderate head injury (GCS 9-13) was associated with good prognosis and low mortality. A greater degree of midline shift of (more than 5 mm) is indicated severe head injury and is significantly associated with morbid outcome and higher mortality.Conclusions: In our study, road traffic accidents is the most common cause of head injury, with males being affected more than females. The degree of midline shift on computed tomography (CT) scan head in patients with head injuries was found to be significantly associated with high mortality and morbidity.
Superior mediastinal tumour excision through upper partial sternotomy and chamberlain incision
Authors: Munjal Ridhika , Pramanik Subrata , Padhy Ajit Kumar , Jadhav Niranjan , Gupta Anubhav
Published: September 2021

Superior mediastinal mass excision can be performed by various approaches such as partial sternotomy, mini trapdoor incision, anterior cervical transsternal approach and lateral thoracotomies. However, adequate exposure especially of superior surface seems to be difficult. Total four patients of superior mediastinal mass were admitted in the department of cardiothoracic and vascular surgery, Safdarjung hospital, New Delhi between June 2019 to May 2021. All of them were operated by upper partial sternotomy with right or left chamberlain extension of incision. It is safe and effective in terms of exposure with early recovery as well as cosmesis. Hence, we advocate the use of upper partial sternotomy with left or right chamberlain incision which provides good exposure in addition to ease of patient position, vascular control and emergency institution of cardiopulmonary bypass.
Single institutional experience of management of penetrating trauma chest
Authors: Jadhav Niranjan Ulhasrao , Pramanik Subrata , Munjal Ridhika , Gupta Anubhav , Mathur Anirudh , Kesharwani Peeyush
Published: September 2021

Chest trauma is now the second most common non-intentional traumatic injury. Chest trauma is associated with high mortality. Control of blood loss and stabilization of vital organs is of vital importance over diagnostic and therapeutic measures. Bleeding may arise from chest wall, intercostal or internal mammary arteries, great vessels, mediastinum, myocardium, lung parenchyma, diaphragm or abdomen. Modified early warning signs (MEWS) score of >9 on presentation have shown higher rate of mortality. Diagnostic modalities such as extended-focused assessment with sonography in trauma (eFAST) have been effective. The type of surgical approach alters according to the site of injury. We here presented our experience with six such patients. All the six patients involved in this study had penetrating trauma chest with various sharp weapons including dagger, ice pick, flag post. Time of presentation of all these patients were delayed due to ours being a tertiary centre. The patients were explored on the basis of eFAST findings, intercostal drainage, hemodynamics. Out of the six patients two patients succumbed and the patients who died also had high MEWS score. All the patients were approached surgically with respect to the type of injury sustained. Penetrating chest trauma present a challenging clinical situation which warrants early evaluation and intervention. The cases of chest trauma then be it blunt or penetrating should always be treated within the advanced trauma life support (ATLS) guidelines followed by the definitive management. Regardless of any penetrating object, the foreign body should be left in situ and only to be removed under vision. If in case the penetrating object has already been removed the operative intervention is decided on the amount of drainage. With blunt chest trauma, approximately 15% of the deaths result directly from intrathoracic injury, but with penetrating chest trauma, nearly 100% of the deaths result from intrathoracic injury. Hence, the operative exploration of the chest in penetrating chest trauma and should be done on emergent basis as the mechanism of injury, vital organ damage and hemodynamic status all equate to higher rate of mortality.
Our experience in treating Fournier’s gangrene at Max Hospital, Gurugram
Authors: Nigam Vinod Kumar , Nigam Siddharth
Published: September 2021

French venereologist Jean-Alfred Fournier described this gangrene as a fulminant gangrene of the penis and scrotum in young men. He reported five cases in his clinical lectures in 1883 though it was first described by Baurienne in 1764. Fournier’s gangrene is a form of necrotizing fasciitis that affects the genital and surrounding perineal and perianal areas. It’s a life-threatening disease leading to 20 to 80 percent mortality. It destroys tissues quickly and infection progresses to septic shock which kills patient if prompt and aggressive treatment is not started. Common symptoms of Fournier’s gangrene are pain in scrotum and or perineum, redness, fever and weakness. Advanced cases have foul smelling discharge from infected tissues. It is due to polymicrobial infection, both aerobic and anaerobic. Fournier’s gangrene is usually diagnosed clinically but imaging investigations such as X-rays, Ultrasound and CT scan help a lot to reach the diagnosis early. Treatment mainly consists of resuscitation, intravenous antibiotics and debridement. We have treated successfully four cases of advanced Fournier’s gangrene with team work of surgeons, anaesthesiologists, physicians and critical care specialists. Full recovery is possible due to a good team work and understanding the disease.
Abdominal emergency related to retro and intraperitoneal lesions caused by COVID-19
Authors: Njoumi Noureddine , Kasouati Jalal , Zentar Aziz , Ali Abdelmounaim Ait
Published: September 2021

Digestive manifestations accompanying or preceding respiratory symptoms of coronavirus disease (COVID-19) caused by severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) are frequent and appears to be associated with its most severe forms. In contrast, isolated digestive involvement in covid-19 is rare and misdiagnosed. It was found that nausea/vomiting, diarrhea, abdominal pain and loss of appetite are the main recognized digestive disorders in patients infected by SARS-COV-2. Acute abdomen with occlusive syndrome has never been reported in the literature to our knowledge. We report the case of a 60-year-old woman who was presented with an occlusive syndrome related to retro and intraperitoneal lesions caused by Covid-19 infection without any respiratory manifestations. She underwent an emergency surgery. The paucity of data about this unusual clinical presentation posed a serious diagnostic and therapeutic challenge.
A case report of spontaneous biliary peritonitis with accessory liver lobe: rare presentation of a rare pathology
Authors: Das Bhuban M. , Ethiraj Suraj , Mohanty Sujit K. , Mohapatra Ramapada
Published: September 2021

Spontaneous intrahepatic bile duct perforation with associated accessory liver lobe is an exceedingly rare condition with very few cases reported in the literature. Here we report a case of 76 years old man presenting with severe pain, abdominal distension since 3 days having jaundice and signs of peritonitis. Having undergone an exploratory laparotomy, 1 liter of bilious peritoneal fluid was seen with a perforation of left intra hepatic bile duct with a presence of an accessory lobe of liver. The gall bladder was contracted with multiple stones. Extrahepatic biliary duct was found normal intraoperatively. A cholecystectomy with resection of the accessory liver lobe was done. Post operatively patient had persistence of jaundice for which a magnetic resonance cholangiopancreatography was done, revealing a distal common bile duct calculus. Patient underwent endoscopic retrograde cholangiopancreatography with stone extraction on post operative day 10 relieving the symptoms. Patient is on regular follow up with no further complications. Awareness of such unusual occurrences is necessary for early diagnosis and instituting the appropriate treatment thereby reducing the mortality.
Clinical assessment of novel plant-based moisturizer “Elovera” in management of dry skin conditions
Authors: Deshmukh Gaurav Anil , Dhoot Dhiraj S. , Barkate Hanmant
Published: September 2021

Background: Moisturizers are major component of basic daily skin care in patients with eczema/dermatitis. Botanical ingredients like aloe vera extract having anti-inflammatory property can be useful in reducing signs and symptoms along with improvement in dry skin in such patients.

Methods: It was retrospective data analysis conducted across 145 centres in India. Patients with eczema/dermatitis who were prescribed Elovera a novel plant-based moisturizer were included in the study. Effectiveness was assessed by evaluating improvement in DASI score, physicians, and patients’ global assessment of disease. Safety was assessed by monitoring all the adverse events reported by the patients.

Results: 402 patients were included in the study. There was significant improvement in mean baseline DASI score with with a reduction of 40.57% and 84.8% at week 2 and week 4, respectively. 86.31% (n=347) and 85.32% (n=343) patients reported significant improvement in their disease as per physician’s and patients’ global assessment of disease. Elovera was well tolerated and only 5 patients reported mild irritation and erythema during treatment.

Conclusions: The result of our study proves that “Elovera” a novel plant-based moisturizer is associated with significant improvement in dry skin, signs, and symptoms of patients with eczema/dermatitis. Based on these results concomitant use of Elovera can be considered along with standard treatment for better outcome in patients with eczema/dermatitis.  
Clinico-radiological profile of COVID-19 in a tertiary care hospital of western Rajasthan
Authors: Soni Priyanka , Kumar Soni Laxman , Agarwal K.C
Published: September 2021

Coronavirus disease 2019 (COVID-19) is a pandemic infectious disease caused by a novel coronavirus, known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Infection by COVID-19 can result in a range of clinical outcomes, from asymptomatic to severe life-threatening course or death.

The purpose of our research was to evaluate the presentation of COVID19 disease based on the clinical and radiological characteristics of our population.

100 COVID19 patients recorded by RTPCR. Clinical, biochemical and radiological data from April-May, 2021.

Of the 100 patients, in our study 66% were males and 26% patients had history of recent travel. Majority of patients were asymptomatic and don’t have comorbid illness. Thrombocytopenia and lymphopenia, increased levels of lactate dehydrogenase (LDH) and serum ferritin and C-reactive protein were common in these patients. CT finding were 63% had normal CT chest. Among the 37% patients who had CT chest findings, 25% had bilateral diseases, 8% patients had right lung involvement while 4% patients have left lung involvement.

 COVID-19 disease has a relatively mild course in this part of the subcontinent. Clinical and laboratory findings are similar to those found in viral diseases. Studies involving larger sample size and interventional trials are need of the hour.
A study to assess the cholesterol levels in pleural fluid and its role in differentiate between exudative and transudate pleural effusion
Authors: Sharvegar Raghurama , Babu S R Chandrik
Published: September 2021

The pathophysiology of the transudate pleural effusion occurs when the systemic factors are involved in the formation and absorption of plural effusion, where the source of pleural fluid is originating from Lung, Peritoneal or Pleural Cavity. The origin of exudative pleural fluid effusion is when capillaries or the pleural surfaces where the fluid originates gets altered. Hence when we the pleural fluid is found to be transudate further diagnostic evaluation is not required and treat the systemic disease affecting it and if the fluid is exudate we need to investigate further to find out the cause of effusion.

To assess the role of pleural fluid cholesterol in differentiating exudative and transudative pleural effusion.

: The present cross sectional study was conducted by the Department of Chest and Respiratory Medicine at Chamarajanagara Institute of Medical Sciences from March 2019 to December 2019. A total of 100 cases of clinically confirmed cases of pleural effusion cases were selected for the purpose of the study.

Based on the Light’s Criteria the Pleural Fluid was analyzed and 94% of them were classified as exudates and 6% of them to be transudates and Pleural fluid cholesterol of more than 45mg/dl 74% of them were exudates and 26% of them were transudates. In the present study based on final diagnosis out of 74 subjects who were classified as exudates, 72 subjects were classified as exudates and misclassified 2 cases as transudate. Lights Criteria diagnosed only 4 cases as transudate pleural fluid among the 26 cases of transudate pleural fluid based on final diagnosis

Light‘s criteria is the most accepted criteria for differentiating between exudates and transudate in pleural effusion. By the Present study we could conclude that the estimation of Pleural Cholesterol Level has good sensitivity, Positive Predictive Value than lights criteria in diagnosing exudative and transudate Pleural Fluid.
Minería en Perú 2021-2030: ¿Qué rol juega en la reactivación económica y el desarrollo territorial?: estudio y recomendaciones sectoriales
Authors: Walter Martín , De Piérola José Carlos , Cooper Claudia , Zegarra Darío , Diez Canseco Carlos , Gobitz Víctor , Laguna Rudy , Liendo César
Published: September 2021

La pandemia por el Coronavirus ha mostrado los retos de la articulación entre el Estado y los sectores económicos, productivos y sociales en el Perú, además de la poca confianza entre el sector público y privado. Todo ello dificulta que las decisiones gubernamentales, cualquiera sea su orientación, encuentren correas de trasmisión que permitan una implementación exitosa. El sector minero juega un rol clave en la economía peruana y será fundamental para la reactivación económica por su capacidad de movilizar inversión privada y de generar ingresos públicos. A su vez, la minería juega un papel preponderante en la estabilidad macroeconómica y el equilibrio fiscal en el Perú pues también representa alrededor de 60% de los ingresos por exportaciones. En el contexto de la pandemia, con el propósito de mejorar a calidad de vida y bienestar de los peruanos más vulnerables, resulta clave impulsar un nuevo enfoque de desarrollo en el territorio donde se generan actividades mineras mediante espacios de articulación público-privada y entornos económicos y sociales sostenibles. Las que siguen son algunas reflexiones de política para las líneas de trabajo en minería en Perú, vía acuerdos entre los sectores público, privado, academia, organizaciones de base, gremios y la sociedad civil.
A Stochastic Frontier Approach Applied to Farms to Selected Andean Countries
Authors: Freitas Carlos Otávio , Silva Felipe de F. , C. R. Neves Mateus
Published: September 2021

In this paper, we estimate a stochastic production function for Bolivia, Ecuador, Colombia, and Peru to investigate whether road infrastructure affects farm technical inefficiency. We use agricultural censuses of Colombia and Bolivia in 2013 and 2014, respectively; national agricultural surveys in 2017 of both Ecuador and Peru; and data on the road network and travel time to the nearest town with 50,000 inhabitants or more. Our main findings are that irrigation increases the value of production and road network decreases farm technical inefficiency, that is, road density (travel time) increases (decreases) farm technical efficiency.
Migration Flows in Latin America and the Caribbean: Statistics on Permits for Migrants
Authors:   Inter-American Development Bank,   Organization for Economic Cooperation and Development
Published: September 2021

Latin America and the Caribbean are experiencing significant changes in migration patterns. The crisis in Venezuela has generated the second largest displacement of people after the one in Syria and is receiving far less international attention and resources. At the same time, there is a large and growing population of Haitians that have migrated to South America, and large numbers are moving from the Northern Triangle of Central America into Mexico and towards the United States, and from Nicaragua into Costa Rica. The new database presented and described in this report compiles data on the number of residence permits granted in fifteen countries of the region by type of permit and nationality of the migrant over a five-year period from 2015-2019. This time frame clearly shows the ongoing transformation of the region from primarily one of emigration to a much more complex scenario of growing intra-regional movements, with all the challenges of countries that send migrants, receive them, and host them in transit. This evolution presents challenges to all countries, and this new database is one measure to better understand these phenomena and help guide policy and investments in the region.
“That Makes Sense Now!": Bicultural Middle School Students’ Learning in a Culturally Relevant Science Classroom
Authors: Kim Deoksoon , Kim So Lim , Barnett Mike
Published: September 2021

This study describes how culturally relevant pedagogy in a project-based science class improved student engagement and comprehension. We focus on bicultural students exploring cultural objects and household inventions with family members, connecting scientific concepts to their families’ funds of knowledge. We use a multiple-case study design to explore six middle school bicultural students’ experiences with culturally relevant activities. Findings describe bidirectional knowledge transfer between the home and the classroom in a way that engaged students, affirmed their home cultures, and facilitated subject matter learning.
A Qualitative Study on Identity Construction among Teachers Working with Students with Disabilities
Authors: Rostami Farzad , Yousefi Mohammad Hosein , Amini Davoud
Published: September 2021

The purpose of this study was to explore multiple facets of the professional identities of Iranian in-service teachers in exceptional schools. The study adopted a qualitative design. The data were collected through in-depth interviews with 14 in-service teachers. The participants were selected through purposeful sampling. Each interview lasted up to 40 minutes. The whole procedure of the data collection was audio-recorded, and verbatim transcriptions were made. Thematic analysis was utilized to analyze the qualitative data. Three themes emerged: relationships, lower identity, and professional identity. The study has some implications for policymakers, curriculum designers, educational psychology, and teacher educators.