bluuebunny/crossref_metadata_2025 huggingface dataset:
An Audit of Antibiotic Prescribing Pattern Among Children in Emergency Settings of a Tertiary Medical College and Hospital
Authors: Manchanda Vikas , Suman Urvashi , Jhamb Urmila , Shaji Rincy
Published: May 2024

Background:

Resistance to antimicrobials is increasing, which leads to a significant increase in mortality, morbidity, and health care costs. In order to promote rational antibiotic uses, standard policies must be set and can be done only after the current antibiotic prescription has been audited.

Objective:

The aim of the study was to describe the antibiotic prescribing patterns in the pediatric emergency of a tertiary care hospital.

Methods:

The data were collected from the pediatric emergency over the period of 6 consecutive days from August 6, 2018 to August 11, 2018. The methodology recommended by the World Health Organization (WHO) for the investigation of drug use in a health facility was followed. The data were analyzed for the percentage of antibiotics prescribed by generic name, prescribed from essential medicine list of government, drugs with fixed-dose combination, and percentage of broad- and narrow-spectrum antibiotics used.

Result:

A total of 600 prescriptions were analyzed in the study. Most of the children were less than 1 year of age (30.8%). Combination of three antibiotics were prescribed in 8.8 % of patients. A 100% of antibiotics were prescribed from the essential drug list. Antimicrobials prescribed by generic name were 52%. Injection ceftriaxone was the commonest antibiotic prescribed (43.3%), followed by amikacin (25.2%). The broad- and narrow-spectrum antibiotics prescribed were 86.6% and 13.4 %, respectively.

Conclusion:

The antibiotics are used cautiously in the paediatrics emergency department of this institute. Among those who were prescribed antibiotics, all prescriptions were from the essential drug formulary. Our findings provide support for investigating antibiotic utilization in other settings and work toward developing a national rational prescribing strategy.
Use of Mobile Phones in Patients with Stroke
Authors: Alvina  , Paul Adithya Philip , Faruqui Atiya R.
Published: May 2024

Objectives:

There is a paucity of systematic studies conducted to get information on the impact of mobile phone radiation on health. This pilot study was done to explore the use of mobile phones in patients with stroke.

Methods:

This cross-sectional study used a structured questionnaire among stroke patients in a tertiary hospital in India. We collected demographic details, history, and information on their mobile phone type, usage, and specific absorption rate (SAR) value. We used descriptive statistics to report our findings.

Results:

This group of 50 stroke patients was predominantly an urban population (78%) with a higher number of male subjects (56%); a higher prevalence of ischemic stroke (76%); 30% were smokers; with comorbidities of hypertension (75%) and diabetes (46%), a significant proportion of whom were not on regular treatment 64% and 74%, respectively. More number of patients used feature phones (82%). The median (SAR) value of all phones was 0.81 W/kg. Hypertension was present in patients who had contact with the phone for >5 hours (78%), subjects who kept their phone closer to the pillow while sleeping (71%), and those carrying a phone in their pockets or on self for >5 hours (80%).

Conclusion:

This group of patients had predominantly ischemic stroke; a significant proportion having hypertension and diabetes were not on regular treatment and were smokers. Cases of hypertension were noted to be higher in patients with increased exposure to mobile phone radiation. As a pilot study with limitations of a small number of patients, these findings could be only incidental. Further research is required to make any conclusions.
Plasma-Cell Myeloma with Double M-Bands on Serum Protein Electrophoresis
Authors: Misra Sunayana , Singh Anu , Kumar Vijay
Published: May 2024

Plasma-cell myeloma (PCM) is a monoclonal gammopathy (MGM) characterized by proliferation of abnormal clone of plasma cells infiltrating the bone marrow with consequent end-organ damage. The clonal plasma cells secrete a single clone of immunoglobulins (Igs) leading to presence of M-protein in the serum and/or urine. The M-protein is appreciated as a discrete band on serum protein electrophoresis (SPE) in the gamma globulin region, also called the M-band. Biclonal gammopathy (BGM) occurs due to neoplastic transformation of a plasma-cell clone undergoing Ig class switching or due to an independent neoplastic transformation event yielding proliferation of unrelated plasma-cell clones, therefore resulting in two distinct M-bands on SPE. It is, however, vital to distinguish a true BGM from an apparent one (MGM presenting with two distinct bands on SPE) so as to make an accurate diagnosis. Hereby, we report a case of a 61-year-old man, diagnosed with PCM and presenting with two discrete bands on SPE (simulating a BGM) which turned out to be monoclonal in nature.
Drug Utilization Pattern in the Treatment of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS CoV 2) Patients at Dedicated COVID Tertiary Care Teaching Hospital
Authors: Singhal Shubha , Bansal Sumit , Negi Ankita , Kalra Bhupinder S. , Gupta Lalit , Garg Sandeep , Sural Sumit , Kapoor Seema , Chawla Shalini
Published: May 2024

Background and aims:

Coronavirus disease of 2019 (COVID-19) has emerged as a pandemic and increasing numbers of patients are being admitted to dedicated COVID hospitals in a city. Since patients were being prescribed investigational, off label, and some approved drugs, it is important to understand and document prescription and drug utilization patterns.

Material and methods:

A prospective observational study was conducted on 1164 RT-PCR positive COVID-19 patients admitted to a dedicated COVID-19 tertiary care hospital. Treatment given to patients with COVID-19 was recorded and evaluated with respect to the place of admission, that is, wards or Intensive Care Unit (ICU). Descriptive statistics were used for the evaluation of data.

Results:

Among the 1164 patients, 670 (57.5%) patients were admitted to the wards while 494 (42.4%) patients were admitted to the ICU. The mortality rate of study participants was 4.1%. Ceftriaxone (39.27%) was the most commonly prescribed antibiotic in the ICU patients while azithromycin (79.10%) was the most prescribed antibiotic in wards patients. 242 (48.98%) patients received dexamethasone whereas methylprednisolone was administered to 88 (17.81%) patients. Remdesivir was administered to 48% of the patients in our study.

Conclusion:

We observed high rates of mortality in patients with one or more comorbidities having SpO2 less than 65. Concordance and adherence to the line of treatment as recommended by Ministry of Health and Family Welfare/ICMR guidelines were discerned. Rational use of antimicrobials is warranted to curb antibiotic resistance and opportunistic infections since most of the patients received empirical therapy.
Role of Erector Spine Plane Block for Postoperative Analgesia in Patients Undergoing Percutaneous Nephrolithotomy
Authors: Bhatia Rohan , Asthana Veena , Sarpal Rajeev , Bindal Kriti
Published: May 2024

Background and objective:

The objective of the present study was to determine the effectiveness of erector spinae plane block (ESPB) for pain relief in patients undergoing percutaneous nephrolithotomy.

Methods:

Sixty-four patients of either sex, American Society of Anaesthesiology (ASA) Grade I/II for surgery were enrolled. After informed consent, all participants received subarachnoid block with 3 ml of 0.5% injection heavy bupivacaine. Participants in the block group received ultrasound-guided ESPB with 30 ml of 0.5% ropivacaine, whereas participants in the control group received routine analgesia as per our hospital's protocol for percutaneous nephrolithotomy procedure which is tramadol 100 mg intravenously. This prospective, single-blind, randomized, controlled study was conducted after approval from the institutional ethics committee (SRHU/HIMS/RC/2019/291) and written informed consent was obtained for surgery under spinal anesthesia. Pain score (visual analog scale, VAS) was evaluated by the anesthesiologist who was not involved in the study at 30 minutes and 2, 4, 6, 8, 12, 18, and 24 hours postoperatively and patient was monitored with electrocardiogram, noninvasive blood pressure, heart rate, and pulse oximetry. Unpaired t test was used for comparison between the groups.

Results:

Both the groups were appropriately matched for age, ASA physical status, weight, and duration of surgery. The total dosing of rescue analgesia, that is, tramadol was considerably more in the control group in comparison with the ESPB group in the first postoperative day (P = 0.000; 218.75 ± 82.06 mg vs. 103.12 ± 47.41 mg, respectively). Similar results were obtained in the VAS pain score.

Conclusion:

ESPB helped in providing considerable postoperative pain relief in patients undergoing percutaneous nephrolithotomy.
A Prospective Randomized Study to Compare Sevoflurane and Desflurane for Emergence and Recovery Characteristics in Pediatric Patients
Authors: Jain Neena , Pareek Pallavi , Sethi Surendra Kumar , Patodi Veena , Mathur Veena , Meena Deepika
Published: May 2024

Background:

Emergence and recovery have been found to be common problems after general anesthesia, especially in children. Both sevoflurane and desflurane have fast emergence and recovery from anesthesia which results in emergence delirium (ED). This study aims to compare the incidence of ED and rate of recovery in pediatric patients under sevoflurane and desflurane anesthesia.

Materials and Methods:

Seventy children aged 1 to 10 years belonging to American Society of Anesthesiologists physical status I or II were enrolled and randomly allocated into two groups. Group D (n = 35) received inhalational desflurane, whereas Group S (n = 35) received inhalational sevoflurane at 1.3 minimum alveolar concentration with oxygen and nitrous oxide for maintenance of anesthesia in both the groups. Rate of recovery from anesthesia (emergence time and recovery time) and incidence of ED were assessed in both the groups. Postanesthesia care unit (PACU) discharge time, hemodynamic changes, and side effects were also noted.

Results:

Emergence and recovery times were significantly shorter in Group D than Group S: (4.50 ± 1.53 minutes versus 6.25 ± 1.64 minutes) and (6.79 ± 1.52 minutes versus 9.12 ± 2.32 minutes), respectively (P < 0.001). No significant difference was observed in the incidence of ED in the two groups (P = 0.782). Mean PACU discharge time was significantly shorter in Group D than Group S (P < 0.001). No significant hemodynamic changes and side effects were noted in both the groups (P > 0.05).

Conclusion:

The incidence of ED was found to be similar with both sevoflurane and desflurane. Although the rate of recovery was significantly faster with desflurane, it was clinically insignificant. Hence, we inferred that both agents can be used safely in children, but sevoflurane should be preferred owing to its properties and cost-effectiveness particularly in our setup.
Nail Fold Capillary Changes in Diabetes Mellitus and Their Correlation with Diabetic Retinopathy
Authors: Bohania Niraj , Singla Sumeet , Pandit Sanjay , Achyut Ban Anuj , Agarwal Richa , Jain Parul
Published: May 2024

Background:

Nail fold capillaroscopy (NFC) is mainly used in connective tissue diseases (scleroderma, mixed connective tissue disease, and inflammatory myositis). It is not used routinely in the evaluation of diabetic patients and no specific patterns of nail fold capillary changes have been established in diabetes. We studied morphological patterns of nail fold capillaries by video capillaroscope in diabetic patients and their association with diabetic retinopathy (DR).

Methods and Material:

Fifty diabetics were recruited after informed consent. The mean age of patients was 49.5 ± 10.6 years. Seventeen patients had DR. Capillary length, capillary density, and various morphological parameters were assessed and these parameters were compared between patients with DR and without DR.

Results:

The most frequent NFC morphological alterations, among diabetics as a group, were tortuous capillaries (56%), giant capillaries (46%), and cross-linked capillaries (44%). Overall, mean nail fold capillary length was reduced in diabetic patients. When individual morphological alterations were compared in patients with DR versus without DR, statistically significant differences were seen for presence of giant capillaries, tortuous capillaries, and avascular areas. On further analysis, mean nail fold capillary length and mean nail fold capillary density were also significantly lesser in patients with DR versus without DR.

Conclusions:

The presence of nail fold capillary morphological abnormalities among diabetics and a significant association with microangiopathic changes in the retina suggest that microvascular changes can be detected early using a simple, non-invasive office-based method of NFC. More large-scale studies in the future can establish a characteristic pattern for diabetes as seen in systemic sclerosis so that microvascular changes in diabetics can be detected at the earliest with the simple noninvasive method by using NFC.
A Prospective Clinical Evaluation of Adhesive Small Bowel Obstruction in Infants and Children
Authors: Banday Mohd Kamran , Shah Waseem Jan , Sudhanshu Akshat , Mufti Gowhar Nazir , Bhat Nisar Ahmad , Baba Aejaz Ahsan , Hamid Raashid
Published: May 2024

Background:

Adhesive small bowel obstruction is a significant cause of postoperative morbidity in children. There are limited studies on the epidemiology and scope of conservative management for adhesive small bowel obstruction in children. The purpose of this study was to determine the presentation, risk factors, and management, including the role of Gastrografin, for adhesive small bowel obstruction in children.

Methods:

Between June 2015 and June 2020, 90 patients with an adhesive small bowel obstruction presented to our pediatric surgery department. Out of these, 10 patients underwent upfront surgery and were excluded, while the rest were put on conservative treatment. Patients who failed to improve after 24 hours of conservative management in the absence of signs of strangulation were administered Gastrografin. Patients were evaluated clinically and radiologically to determine the resolution of the obstruction.

Results:

The mean age was 9.04 ± 3.89 with sex a ratio of 2.6:1. Vomiting was the most symptom (90% cases), followed by pain abdomen (87.5%). Appendectomy (50%) and enterotomy for worm obstruction (17.5%) were the most common previous surgical procedures leading to acute small bowel obstruction. Recurrent obstruction was seen in 7.5% of the cases. Thirty eight (47.5%) patients were successfully managed conservatively by standard decompression therapy. Oral administration of Gastrografin successfully resolved the obstruction in 43% patients who failed standard decompression therapy, whereas 24 (30%) patients with persistent obstruction required laparotomy.

Conclusion:

Adhesive small bowel obstruction is a common surgical emergency in children. It can occur at any age and after laparotomy for any surgical condition; however, history of appendectomy is associated with high incidence of adhesion obstruction. Vomiting and abdominal pain are constant symptoms. Conservative management with standard decompressive therapy followed by using water-soluble contrast agents (Gastrografin) is a safe and effective approach in managing adhesion obstruction in selected children without signs of bowel ischemia.
Evaluation of Variation in Tear Film Breakup Time (TBUT) in Computer Users According to Hours of Computer Usage
Authors: Gahlot Abha , Naorem Holmes , Singh Divya , Kapur Monika , Goyal Jawahar Lal , Arora Yogesh
Published: May 2024

Background:

Increased use of computers over prolonged hours leads to a decrease in tear film breakup time (TBUT), resulting in dry eye. This study was carried out to find out the variations in TBUT according to hours of daily computer usage.

Methods:

Computer users were grouped into five groups as group A <2 hours, group B >2 hours to ≤4 hours, group C >4 hours to ≤6 hours, group D >6 hours to ≤8 hours, and group E >8 hours according to their hours of computer exposure per day. All the participants were subjected to TBUT. Chi-squared test and analysis of variance test was used to compare mean values, find P-values, and ensuring statistical significance.

Results:

In our study, the mean age of the study population was 32.18 ± 5.38 years. The mean TBUT in the various groups was found to be 25.83, 21.20, 18.62, 12.40, and 9.43 seconds in the right eye and 26.05, 21.19, 18.57, 12.31, and 9.41 seconds in the left eye in groups A, B, C, D, and E, respectively.

Conclusion:

It seems there is significant decrease in TBUT with increasing duration of computer use per day. TBUT can be performed quickly, easily, and be used to screen and support diagnosis of dry eye.
Assessment of Vitamin A Status in Patients with Iron Deficiency Anemia
Authors: Aggarwal Sunita , Verma Abhishek , Tiwari Surendra , Kaushik Smita , Garg Sandeep , Kumar Suresh
Published: May 2024

Introduction:

Iron and vitamin A deficiency are two very prevalent and easily preventable nutrient deficiencies. This study was conducted to assess vitamin A status in patients with iron deficiency anemia and to further study the correlation of vitamin A status with biochemical markers of iron deficiency.

Materials and Method:

Eighty patients with iron deficiency anemia were enrolled and investigated for a complete blood count, an iron profile, liver, and kidney function tests and plasma retinol binding protein levels. The mean age of patients was 31.14 ± 11.33 years, with a range of 16 to 62 years.

Results:

Mean hemoglobin was 7.19 ± 2.1 g/dL. Serum iron, ferritin, and transferrin saturation were low in all patients, while total iron binding capacity (TIBC) was elevated in only 74 patients (94.81%). Nineteen patients (23.8%) had vitamin A deficiency, with a mean retinol binding protein (RBP) 0.53 ± 0.13 µmol/L. Vitamin A deficient patients had a mean hemoglobin of 6.8±2.14 gm/dL, mean corpuscular volume (MCV) 71.35 ± 8.86 fL, a mean corpuscular hemoglobin (MCH) 19.43±4.36 pg, mean corpuscular hemoglobin concentration (MCHC) 25.44±4.92 gm/dL, serum iron of 28.21 ± 9.73 mcg/dL, serum ferritin 13.04 ± 12.41 ng/mL, transferrin saturation 6.81 ± 3.07%, and TIBC 427.85 ± 78.57 mcg/dL. Among vitamin A deficient patients, RBP had positive correlation with serum iron and transferrin saturation; while, simultaneously showing negative correlation with serum ferritin and TIBC.

Conclusion:

Vitamin A deficiency affects iron metabolism, causing abnormal iron trapping and systemic iron deficiency, thus worsening the clinical profile of iron deficiency anemia. This study guides us to screen iron deficiency anemia patients for the concomitant vitamin A deficiency for efficient treatment of such patients.
Clinical profile and outcome of AKI in snake bite in a tertiary care hospital, India
Authors: Acharya Aruna , Naik Haladhar
Published: May 2024

Introduction:

Acute kidney injury (AKI) is one of the complications of envenomation that is frequently fatal.

Aim:

To evaluate the clinical profile and outcome of AKI in snake bite patients and to identify the predictors of mortality in these patients.

Methods:

All patients admitted with history of envenomation and AKI were included in the study. A detailed history was obtained from all the patients about the time of antisnake venom administration and time interval between the event and admission in hospital, and then hematological and biochemical investigations were performed.

Results:

A total of 202 patients were diagnosed with snake bite induced AKI, of which 8.6% had died. Majority of patients were males (82.7%). The dialysis requirement was significantly higher in patients who died as compared to those who survived (100% vs. 72.6%, p = 0.013). The disseminated intravascular coagulation was found to be higher in patients who died due to snake bite (p < 0.001). The median (range) length of hospitalization was shorter for the nonsurvivors than the survivors (3.0 [1.0–4.0] days vs. 8.0 [3.0–27.0] days; p < 0.001). Compared to patients who survived, the total leukocyte count and serum urea were significantly higher among patients who died due to snake bite induced AKI.

Conclusion:

The present study revealed that higher dialysis requirement, high complication rate, and lower duration of hospital stay were the risk factors associated with patients who died due to snake bite induced AKI.
Experience of Orthopedic Surgeons Managing COVID Patients at the Peak of Second Wave in a COVID-dedicated Hospital
Authors: Sural Sumit , Suri Tarun , Khan Yasim , Yadav Pankaj , Meena Abhay , Yadav Rajeev , Maini Lalit , Kumar Vinod
Published: May 2024

Introduction:

The second wave of the severe acute respiratory syndrome coronavirus-2 pandemic in April 2021 had a sudden deluge of moderate to severe patients getting admitted to the orthopedics block, due to scarcity of beds in the medical wards, high dependency and intensive care areas of the hospital. This study is an analysis of these patients managed in the orthopedics block by orthopedic surgeons, which may be useful to formulate guidelines for the management of patients in future waves of the coronavirus disease 2019 (COVID-19) pandemic.

Methods:

The data of patients were collected by orthopedic residents from the Google sheet which was uploaded daily as part of the hospital data. The data from Google sheet were downloaded and compiled into an excel workbook and analyzed for patient progress, outcome, comorbidities, treatment given, oxygen management, and death analysis.

Results:

The data of 319 patients admitted from April 17, 2021 to May 20, 2021 in orthopedic block depicted successful recovery and discharge of 160 patients, worsening and transfer to higher wards for 126 patients and 33 deaths. The average age of these patients was 53.43 years with male preponderance (71% male). At the time of admission, 78.05% were reverse transcription polymerase chain reaction/rapid antigen test positive and 21.9% were COVID suspects. The patient's disease status on arrival was found to be mild in 21.3%, moderate in 43.8%, and severe in 34.7%. The most common comorbidity was hypertension in 39 patients followed by diabetes in 29 patients. The average number of days of hospital stay was 5.48 days.

Conclusion:

Medical professionals other than critical care medicine can be frontline care providers who can guide the ancillary departments at the peak of pandemic waves. Adherence to the standard operating protocols and interdepartmental coordination need to be effectively managed. This study can be used to formulate guidelines for further improvement in COVID patient care in case of future waves of this pandemic.
Reporting of Animal Research Studies in Concordance with ARRIVE Guidelines in Indian Medical Journals
Authors: Sawachia Kavita , Singhal Shubha , Mishra Ankita , Kalra Bhupinder Singh
Published: May 2024

Background:

Inappropriate reporting of animal studies has been a serious issue. The Animals in Research: Reporting in Vivo Experiments (ARRIVE) guidelines were published to improve design, analysis, and reporting of animal studies.

Methods:

The present study is a retrospective observational study of published original research using small laboratory animals. Studies published between the year 2015 and 2020 in Indian Journal of Medical Research (IJMR), Indian Journal of Pharmacology (IJP), Indian Journal of Experimental Biology (IJEB), and Journal of Pharmacology and Pharmacotherapeutics (JPP) were reviewed in accordance with ARRIVE guidelines.

Results:

Three hundred and seventy-seven studies (JPP n = 15, IJMR n = 37, IJEB n = 157, IJP n = 167) were analyzed. A statement regarding ethics approval was reported in 90.2% of studies. Information regarding randomization and blinding was reported in 20.4% and 0.53% of studies, respectively. Only nine studies mentioned sample-size calculation. Macroenvironmental information such as room temperature/humidity were detailed in 87.5% and light/dark cycle in 96.5% of studies. Concerning microenvironmental conditions, access to food and water was reported in 75% of studies. Only 6.3% studies mentioned the details of adverse events. Information regarding humane endpoint was missing in all studies.

Conclusion:

Inappropriate and inadequate reporting in some areas of animal research need to be curbed by adhering to ARRIVE guidelines.
Efficacy of Single-Dose Ivermectin on Virologic and Clinical Recovery in COVID-19
Authors: Saxena Romit , Rajanagam Muthu , Jhamb Urmila , Manchanda Vikas , Saxena Sonal , Pallavi
Published: May 2024

Background:

Coronavirus disease 2019 (COVID-19) pandemic mounts an ever increasing challenge on healthcare resources. Ivermectin shows promise in in vitro studies on coronavirus, but there are few prospective trials on currently approved dosage recommendation for the treatment of COVID-19.

Aims:

To study the virologic and clinical recovery after single-dose ivermectin, given within first 5 days of symptom onset.

Settings and design:

Prospective, open-labeled, randomized controlled trial. Patients were recruited in between August 30, 2020, and November 6, 2020, at a single referral center for patients with COVID.

Materials and methods:

The study participants included patients presenting with severe acute respiratory syndrome coronavirus 2 infection. The patients were randomized to receive a single-dose ivermectin, 0.2 mg/kg in the treatment group (TG). Both groups [TG and control group (CG)], continued to receive standard treatment.

Results:

The recruited cohort was comparable in the two arms of the study, except age and height. There was no statistically significant difference in virologic clearance between the two arms (percentage COVID positive day 7: TG: 34.2% vs. CG: 52.6%, P = 0.165).

Conclusion:

Our study shows that after administration of single dose of currently approved doses of ivermectin (0.2 mg/kg), there does not exist a significant virologic or clinical recovery in COVID-19 disease.
A Rare Case of COVID-19 Infection Presenting as Massive Pericardial Effusion in Young Adult
Authors: Joshi Sharad , Tayal Nitesh , Bhatia Ankit
Published: May 2024

Novel coronavirus disease 2019 (COVID-19) has emerged as a rapidly spreading viral illness throughout the world. Majority of patients develop pulmonary manifestations. Involvement of extrapulmonary site is rare. We here present a rare case of massive pericardial effusion as a presenting feature of COVID-19 infection.
Spontaneous Resolution of Type 1 Macrocystic Congenital Cystic Adenomatoid Malformation
Authors: Kumar Shishir , Panda Shasanka Shekhar , Neogi Sujoy , Ratan Simmi K
Published: May 2024

We present a case of 6-month-old boy who presented with respiratory distress due to empyema, which was initially managed by the intercostal drain. Computed tomography scan confirmed the diagnosis of type 1 congenital cystic adenomatoid malformation (CCAM). Subsequently, there was the spontaneous resolution of empyema and CCAM prior to surgical intervention. Our case illustrates the postnatal spontaneous resolution of CCAM, which is rare.
Evaluation of Efficacy of Two Different Doses of Intravenous Lidocaine in Patients with Chronic Pain
Authors: Ghai Anju , Verma Bharti , Rohilla Kanika
Published: May 2024

Background:

An intravenous infusion of lidocaine has been used on numerous occasions to produce analgesia in neuropathic pain. It has been shown to be beneficial for the treatment of variety of neuropathic pain states in a wide range of dosage, from 2 to 7.5 mg/kg. The aim of our study was to evaluate the efficacy of two different doses of intravenous lidocaine (3 and 4 mg/kg) in patients with chronic pain.

Methods:

Patients above the age of 18 years suffering from chronic pain due to postherpetic neuralgia, post-surgical scar pain, chronic low back pain having numeric analogue scale (NAS) pain score of ≥3 without satisfactory pain relief from conservative treatment were randomised to receive either 3 mg/kg or 4 mg/kg intravenous lidocaine in 250 mL normal saline infusions weekly over a period of 1 hour for 3 weeks. NAS was measured before starting each infusion, immediately after completion of infusion, 2 and 24 hours, 7th day, 14th day, 21st day, and 28th day.

Results:

NAS score at first hour and 24th hour was significantly reduced (P = 0.001), after each infusion [7th, 14th day] in both the groups. There was no statistical difference in pain score among both groups except for day 7 (P value 0.04). Reduction in NAS score was also present on 21st and 28th day in both groups, but it did not reach a significant value. On 28th day, NAS score values showed increasing trend. Duration of pain relief was around 1 week after each infusion in both groups.

Conclusion:

Intravenous lidocaine at a dose of 3 mg/kg or 4 mg/kg was effective in reducing pain in patients with chronic pain. The analgesic effect was not different among both groups. Trend of greater response was observed with 4 mg/kg dose.
Herpes Zoster Oticus
Authors: Swain Santosh Kumar , Paul Roshna Rose
Published: May 2024

The reactivation of varicella zoster virus (VZV) at the geniculate ganglion of the facial nerve results in herpes zoster virus. Patients of herpes zoster oticus (HZO) often present with symptoms related to the cochleovestibular dysfunction along with otalgia and vesicular eruption at the pinna and external auditory canal. Patients of HZO usually present with hearing loss, vertigo, and facial nerve paralysis. When it is associated with facial nerve paralysis, HZO is called Ramsay Hunt syndrome (RHS). In the majority of cases, patients with vertigo have hearing loss, whereas patients without hearing loss have no vertigo. It is a self-limiting viral disease and the morbidity is often caused due to facial nerve paralysis. If HZO is not diagnosed immediately and treated timely often it progress to RHS. Clinician education is vital for detecting the HZO/RHS at an early stage so that facial nerve paralysis can be prevented along with associated morbidity. In this review article, we discuss the current concept and recent advances in the etiopathology, diagnosis, and treatment of HZO.
Amphotericin B Revisited
Authors: Kumar Sahil , Roy Vandana
Published: May 2024

Amphotericin B, one of the first systemic antifungal agents, has been in use since the past six decades. In light of the recent outbreak of mucormycosis (black fungus) cases during the second coronavirus disease 2019 wave in India, the relevance of knowing the chief aspects of this drug has been renewed. This drug review attempts to revisit the important details available about this agent, which will be of use to the clinician.
Stigma and its Associated Factors among People Living with HIV/AIDS (PLHA) Attending ART Centre in a Tertiary Care Institute in Kolkata
Authors: Adhikari Kaushik , Dutt Debashis , Pal Dipak , Hazra Suprakas
Published: May 2024

Background:

AIDS stigma exists in a variety of ways, including ostracism, rejection, discrimination, and avoidance of HIV-infected people. Some people are rejected by family and community, whereas others face poor treatment in healthcare and educational settings, erosion of their rights, and psychologic damage. All these limit access to HIV testing, treatment, and other HIV services.

Objectives:

This study was undertaken to determine the proportion of patients with severe stigma among people living with HIV/AIDS (PLHA) and to identify the factors associated with it.

Materials and methods:

It was a cross-sectional study conducted among 444 PLHA, attending ART center of a tertiary care institute of Kolkata, chosen by systematic random sampling. Berger scale was used to classify stigma as no, mild, and severe stigma. Logistic regression analyses were performed to identify the risk factors.

Results:

About 32.7% of PLHA had experienced severe forms of stigma. These were severe forms of personalized stigma (33.8%), negative self-image (25.9%), perceived public attitude (27.5%), and disclosure concerns (30.0%). Overall severe stigma was higher in females (33.3%) than males (31.8%). After binary logistic regression, factors significantly associated with severe stigma included age [adjusted odds ratio (AOR) 1.564 (1.071–2.285), sig: 0.021], socioeconomic status [AOR 0.748 (0.574–0.974), sig: 0.031], HIV status known to the partner [AOR 19.965 (3.3673–78.357), sig: <0.0001], presence of comorbidities [AOR 8.497 (3.541–20.389), sig: <0.0001], and possible mode of transmission not known by the patient [AOR 0.615 (0.380–0.993), sig: 0.047].

Conclusion:

Study found that those who were older, who were from lower socioeconomic group, whose partner knew their disease status, who were having comorbidities, and who do not know their mode of infection experienced a higher level of HIV-related stigma.
Effect of Traditional Raga Therapy on Depression, Anxiety, and Stress Level in Preoperative Patients Undergoing Cataract Surgeries
Authors: Achar Asha , Talwar Badrinath , Kumar Ashok , Addanki Purna Singh
Published: May 2024

Background:

Psychologic behavior plays a key role in the outcome of any treatment or therapy. It was recommended to assess the psychologic status of the patient along with the clinical examination and also counsel him with adequate management therapies. Ragas have a high impact on mental well-being. Listening to ragas was reported to be highly effective in regulating the blood pressure and heart rate.

Methods:

The present study involved 30 (10 males and 20 females) preoperative patients who will be undergoing cataract surgery in 2 days and within the age group of 55 to 60 years from the ophthalmology department. The patients were subjected to listen to Raga Bhairavi for 30 minutes for 2 days.

Results:

There is a significant decrease in depression anxiety and stress levels followed by raga therapy.

Conclusion:

There is a significant decrease in depression anxiety and stress levels followed by raga therapy. There is a strong need for further studies with multiple centers and a higher sample size to recommend raga therapy in the management of mental health problems in the patients.
Reduction of Aerosol Exposure to Orthopedic Surgeons while Drilling Bone in COVID-19 Era
Authors: Dutt Saurabh , Bhatia Nishant , Singh Pritish , Sehrawat Rakesh
Published: May 2024

Operating in coronavirus disease times has become a challenge as it risks the frontline task force. Till now, no definitive and clear-cut guidelines for reducing aerosol generating procedures using the orthopedic power tools have been issued by the World Health Organization. We describe a technique to reduce aerosol generation in orthopedic procedures especially during drilling while inserting a screw or pin. We tooled a piece of polycarbonate plastic glass into a cup-shaped configuration and made two working portals, one through which a drill bit/sleeve could be advanced and the other through which a suction catheter could be inserted to suck out the dangerous fumes while drilling.
Diaphragmatic Hernia in Pregnancy – a Case Report
Authors: Tempe Anjali , Bali Vedika , Kumar Devender , Guguloth Chaithanya
Published: May 2024

Background:

Maternal diaphragmatic hernias (DH) identified during pregnancy are rare and pose significant management challenges with respect to the timing of delivery, mode of delivery, and hernia repair.

Case presentation:

We describe a case of traumatic maternal DH, diagnosed at 31 weeks of gestation presenting with multiple episodes of vomiting. Owing to no evidence of visceral compromise and a stable maternal and fetal condition, the patient was conservatively managed allowing further fetal maturation and was delivered by cesarean section at 34 weeks. This was followed by laparoscopic intraperitoneal mesh hernial repair at 6 weeks postpartum. The patient had an uncomplicated recovery.

Conclusion:

Maternal DH in pregnancy require multidisciplinary care and individualized management for the optimal outcome for mother and fetus.
Iliopsoas bleeds in patients with hemophilia
Authors: Varadarajan Meera , Ramaiah Smitha
Published: May 2024

Background:

Iliopsoas bleed is a serious complication in people with hemophilia (PWH), with significant morbidity. Studies examining the profile, incidence, and outcomes in psoas bleeds are scarce and will shed more light and increase awareness about its management.

Material and Methods:

Data of 453 PWH with confirmed iliopsoas bleed treated at Bangalore Medical College were retrospectively analyzed.

Results:

Eighty-five (18.8%) PWH presented with total of 154 psoas bleeds. Their mean age was 21.96 years. Common symptoms were thigh/hip/groin pain (100.0%), hip flexion spasm (41.2%), numbness/tingling in quadriceps muscle (5.9%), abdominal tenderness (3.5%), hematuria, and anemia requiring blood transfusion in 2.4% each. Long-term complications were quadriceps atrophy (9.4%), permanent abnormal posture (10.6%), transient paresthesia in the distribution of femoral nerve (3.5%), and pseudo tumor in pelvis (1.2%). The overall average duration of therapy with clotting factor concentrate was 1.7 days with a mean duration of therapy of 1.4 days in patients without inhibitors and 2.8 days in patients with inhibitors (p = 0.010). The overall mean duration of hospitalization was 7.2 days with 5.3 days in PWH without inhibitors and 8.3 days in PWH with inhibitors (p = 0.342).

Conclusion:

Pain in hip joint/groin/hip flexion spasm suggests the possibility of an iliopsoas hematoma and early factor replacement therapy should be started to prevent complications. Early treatment at first sign of discomfort reduces the duration of treatment, and prevents severe complication and invasive interventions. Patients with inhibitors were overrepresented in the cohort who needed longer duration of factor replacement therapy.
Seroprevalence of Sexually Transmitted Infections (Hepatitis B Virus, Hepatitis C Virus, Syphilis, and Hiv) in Pregnant Women and Evaluation of Sociodemographic Characteristics and Awareness Regarding Stis in North Indian Population
Authors: Bhatia Ruby , Mehta Girisha , Sidhu Sukhbir Pal Kaur , Arora Trisha , Raina Renuka
Published: May 2024

Context:

Sexually transmitted infections (STIs) are a problem of increasing concern among men and women. They can affect fertility, increase maternal and neonatal morbidity, and can become a burden on both physical and emotional health. Owing to lack of awareness and partly due to the social stigma attached, couples do not come forward for screening. Antenatal testing for STIs is an effective strategy recommended to detect STIs in this subset of the population.

Aims:

To estimate the seroprevalence of four STIs (hepatitis B, hepatitis C virus, HIV, and syphilis) in pregnant women, to evaluate its correlation with sociodemographic characteristics and sexual behavior, and to check awareness regarding STIs.

Settings and Design:

It was an observational study on 500 pregnant women attending an antenatal clinic at a tertiary care hospital in rural Haryana, India.

Methods and Material:

Pregnant women were screened for four STIs – hepatitis B, hepatitis C virus, HIV, and syphilis.

Statistical Analysis Used:

The sample size was calculated considering the mean reported seroprevalence of infections in pregnant women in previous studies. The power of the study was kept 80% and the alpha error was 0.05.

Results:

Seroprevalence for STIs in pregnancy was 5.2% – hepatitis C virus (2.6%), hepatitis B (2.4%), and syphilis (0.4%).

Conclusions:

Viral STIs are more prevalent among pregnant women. Antenatal screening is an effective strategy for the detection of STIs in pregnant women.
Acceptance of COVID-19 Vaccine and Its Related Determinants Among the Residents of Western Uttar Pradesh
Authors: Panwar Aprajita , Tyagi P.K. , Bhargava Apoorva , Gupta Rakesh K.
Published: May 2024

Background and Objectives:

Amidst multiple waves of the coronavirus disease 2019 (COVID-19) pandemic, numerous vaccines are being used worldwide to provide immunity against the coronavirus. Knowledge, attitudes, and perceptions of the community toward COVID-19 vaccination could influence vaccine acceptance. This study aimed to evaluate the knowledge, attitudes, and perceptions toward COVID-19 vaccination and assess its determinants.

Material and Methods:

A web-based cross-sectional study was conducted as a structured 27-item questionnaire through Google Forms. Qualitative data were processed by categorizing responses for an item according to intended objectives, and data were coded numerically. The associations between variables were explored by using a modified Poisson regression to determine adjusted prevalence ratios and their 95% confidence intervals.

Results:

The vaccine acceptance rate among the respondents was 72% and was more among those involved in the health care sector. The participants feared vaccine-related side effects and were less willing to accept the vaccination. The participants who believed adults also require vaccination against diseases accepted the COVID-19 vaccine. We found that the subjects with comorbid conditions, urban areas, and those who had contacted COVID-19 infection or family members were more willing to get vaccinated (P < 0.001).

Conclusions:

We concluded that a considerable majority (72%) of residents exhibit good vaccine acceptability. Health care providers, social media, and community influencers can design awareness campaigns to address perceived safety concerns and achieve a 100% acceptance rate in the community.
Prevalence and Factors Associated with Morbidity among Postmenopausal Women in a Rural Area in Kozhikode District
Authors: Shamin P. R. , Kannan S. Suthanthira
Published: May 2024

Introduction:

The focus of women's health researchers and health policy planners has also shifted toward postmenopausal women since recent trends suggest an increase in their number and life expectancy. In general, women have more complex and stressful aging process as men do, as a consequence of hormonal changes that occur during menopausal transition.

Objectives:

The objective of this study is to estimate the prevalence of postmenopausal symptoms among women in a rural area of Kozhikode and study factors associated with it.

Material and Methodology:

A cross-sectional study was conducted among postmenopausal women aged 40–55 years in Nanminda panchayat, a rural area in Kozhikode district. This 1-year study was conducted from June 2015 to June 2016, had 245 participants with informed consent. There are 17 wards (17 clusters) in Nanminda panchayat area from which 6 wards were selected. The prevalence of postmenopausal symptoms and associated factors such as sociodemographic profile, morbidity details, diet supplements, anthropometric, clinical, and reproductive components was assessed using the pretested semistructured questionnaire.

Results:

A total of 245 postmenopausal women were studied. The prevalence of postmenopausal symptoms was found to be 64%. The mean age of the study population was 50.87 years. Age, education, marital status, menopausal age, and duration of menopause were found to be significantly associated with the presence of postmenopausal symptoms. Intake of Calcium supplements was found to be having protective effect against menopausal symptoms. Binary logistic regression revealed that age, educational status, marital status, and dietary intake of calcium supplements are significantly associated with postmenopausal symptoms.

Conclusion:

Women with early age of menopause and less duration since menopause had more risk of having postmenopausal symptoms. The prevalence of symptoms was found to be less if calcium supplements were taken.
Effect of anxiety, stress, and depression on hypertension and diabetes during COVID-19 lockdown period in Faridabad
Authors: Arora Utkarsh , Chaudhary Chetana , Babu G. Krishna , Kona J S Surya Prabha , Babji K.
Published: May 2024

Background:

The SARS-CoV-2 pandemic with a high contagion potential poses a pathological threat to the community but has a larger psychological impact, elemental in the aggravation of blood pressure and blood glucose levels. The aim of this study is to examine and interpret the effect on individuals, with or without preexisting diabetes and hypertension, of depression, anxiety, and stress and to assess the factors associated with exacerbation of blood pressure and blood glucose levels.

Materials and Methods:

A cross-sectional observational study was carried out through a snowball sampling method in Faridabad. A predesigned and pretested questionnaire was circulated on Google Forms. A total of 1002 responses accorded with our inclusion criteria and were involved in the final analysis.

Results:

In the general population, 20.7%, 42.4%, and 39.4% of individuals experienced moderate-to-severe stress, anxiety, and depression, respectively. The prevalence of stress (22.6%) and anxiety (52.9%) was higher in people with preexisting hypertension and diabetes as compared to people without these preexisting comorbidities. Participants with severe depression and severe anxiety had blood sugar level aggravation 5.55 times and 10.10 times more than the ones with lower depression and lower anxiety. Individuals with severe anxiety experienced exacerbation of blood pressure levels 7.35 times more than individuals with lower anxiety.

Conclusion:

Individuals experienced high mental distress during the lockdown period, especially the ones with preexisting health conditions, who displayed a higher incidence of depression, anxiety, and stress. The results further point toward a bidirectional relationship between hypertension and diabetes with mental health as people with preexisting health conditions experienced greater psychological stress than others.
Prevalence of depression, anxiety, stress, and substance use among medical undergraduates
Authors: Chauhan Pooja , Katkuri Sushma
Published: May 2024

Background:

Prevalence of anxiety and depression indicates the mental health status of the community. Prevalence of stress among the medical students varies from 12% to 73%. They affect their curriculum. Substance use affects their health and academics. It has been estimated by the World Health Organization that there are about 2 billion people who use alcohol, 1.3 billion people who smoke, and 185 million people who use the drugs.

Objective:

The objective is to study the prevalence of depression, anxiety, stress, and substance use among medical undergraduates.

Materials and Methods:

This cross-sectional survey was conducted among 243 medical and students of a medical college, during the period of November to December 2015. The students were contacted keeping the privacy, and the data were collected in the prescribed study questionnaire. The name, batch, or registration number was not enquired to maintain the confidentiality.

Results:

The prevalence of depression was 39.1%; mild = 15.2%; extremely severe = 0.8%; moderate = 18.5%. The prevalence of anxiety was 48.5%; mild = 11.5%; extremely severe = 8.6%; moderate = 14.8%. The prevalence of stress was 34.6%; mild = 18.9%; extremely severe = 0.8%. 97 students expressed their inability to concentrate during classes. 15.2% were involved in violence while 14% had thoughts of self-harm/suicide. 54.2% preferred parents as their primary support approach for mental support. 23.5% told the reason for not approaching mentors as they were not accessible. The prevalence of smoking was 5.7%; that of alcohol was 5.7%; and that of tobacco chewing was 3.3%. 12.2% had father as their role model for substance use and 3.6% initiated it out of curiosity.

Conclusion:

The prevalence of depression, anxiety, and stress as well as substance use was high in these medical and students. Consequences of mental health issues are lethal. Father was the most common role model for substance use among these students.