bluuebunny/crossref_metadata_2025 huggingface dataset:
To Access The Potential of Point of Care Ultrasound to Differentiate Various Causes of Dyspnea In Emergency Department
Authors:   Senior resident, Department of Emergency Medicine, Medical College, Baroda 390001, Gujarat, India., Atul I Bhoraniya , B Parikh Rina ,   Assistant professor, Department of Emergency Medicine, Medical College, Baroda 390001, Gujarat, India., Kumar H Pancholi Krunal ,   Assistant professor, Department of Emergency Medicine, Medical College, Baroda 390001, Gujarat, India., K Patel Shreyas ,   Assistant professor, Department of Emergency Medicine, Medical College, Baroda 390001, Gujarat, India., Rahul H Humbal ,   Senior resident, Department of Emergency Medicine, Medical College, Baroda 390001, Gujarat, India., Himanshu Gupta ,   Resident, Department of Emergency Medicine, Medical College, Baroda 390001, Gujarat, India.
Published: January 2024

Management of the patients presented with dyspnea can be challenging in emergency department(ED), because differentiating underlying cause can be difficult and time consuming. Point of care ultrasound(POCUS) examination in early evaluation of critical patients have been reported to be helpful in rapid diagnosis of causes of dyspnea which in turn helps in early Resuscitation. Aim: We performed this study to assess utility of POCUS in differentiating causes of dyspnea & compared with final diagnosis at the time of discharge/death. Settings and design: This was a single centre prospective diagnostic study to assess utility of POCUS in dyspnea. It was approved by ethical committee. Materials and methods: The study was conducted at ED of tertiary care government hospital in Central Gujarat from December 2018 to November 2019. All patients presenting with dyspnea to ED were included after written informed consent. Patients’ age < 12 years, Patients not willing for admission, and Patient who took discharge against medical advice /absconded/died before establishing final diagnosis were excluded. Provisional diagnosis made through POCUS was compared with the final diagnosis made by the consultants of respective clinical departments during course of their hospitalization. Statistical analysis and results: 146 patients with dyspnea presenting to ED were included in prospective observational study. True and False positives, sensitivity and specificity were calculated from the analysis of data. Reliability index was calculated on the basis of above data. *Conclusion: This study showed good efficacy of POCUS in differentiating causes of dyspnea when compared with final medical diagnosis. Thus POCUS helps in early resuscitation and management.
A Case Report of Atropine Psychosis in Organophosphorus Poisoning: Glycopyrrolate used Successfully as a Replacement
Authors:   Senior resident, Department of Anesthesia, Critical Care and Pain, Shillong 793018, Meghalaya India., Deb Prakash , Singh Aaashish Kumar ,   Junior resident, Department of Anesthesia, Critical Care and Pain, Shillong 793018, Meghalaya India., Bhattacharyya Prithwis ,   Professor and head,  Department of Anesthesia, Critical Care and Pain, Shillong 793018, Meghalaya India., Yunus Md ,   Additional Professor, Department of Anesthesia, Critical Care and Pain, Shillong 793018, Meghalaya India.
Published: January 2024

Atropine is the most commonlyused drug for the treatment of organophosphorus poisoning which may occasionally lead to central nervous system side effects like psychosis and delirium. Discontinuation of atropine, modification of the dosage or replacement with other medications may be required alongwith antipsychotics and sedatives in such cases. We report herein a case of suicidal ingestion of organophosphorus insecticide (ANACONDA) who received atropine infusion for the management of muscarinic symptomsbut developed psychotic features during treatment. Atropine was discontinued and replacement done with glycopyrrolate infusionwhich could successfully counteract the muscarinic features. The use of glycopyrrolate as replacement in atropine psychosis and the recommended dosage regimen has been sparsely described in literature.
Shock Index and Modified Shock Index as Predictors of 24 Hour Mortality in Patients with Polytrauma
Authors:   Professor and HOD, Department of Anesthesiology,Pandit Jawaharlal Nehru Memorial Medical College and Dr. BR Ambedkar Hospital, Raipur, Chattisgarh 492001, India., Shah Pratibha Jain , Sundrani Omprakash ,   Associate Professor and HOD, Department of Critical Care Medicine, Pandit Jawaharlal Nehru Memorial Medical College and Dr. BR Ambedkar Hospital, Raipur, Chattisgarh 492001, India., Priyadharshini K Lily Sharon ,   Final Year Resident, Department of Anesthesiology,  Pandit Jawaharlal Nehru Memorial Medical College and Dr. BR Ambedkar Hospital, Raipur, Chattisgarh 492001, India.
Published: January 2024

Abstract Context: The failure of the vital signs to predict the severity of shock and the drawbacks of the trauma scoring systems have led to extensive research on shock index in polytrauma patients. This prospective, observational study was conducted to study the efficacy of the Shock Index (SI) and Modified Shock Index (MSI) as predictors of 24 h mortality in polytrauma patients. Aim: To validate the Shock index and Modified Shock index as predictors of 24 h mortality in polytrauma patients. Method: All patients presenting with polytrauma meeting the inclusion criteria were evaluated using the following parameters: Heart rate, Systolic blood pressure, and Diastolic blood pressure, following which SI and MSI were calculated. Abbreviated Injury Score (AIS) & Injury Severity Score (ISS) were formulated. The endpoint of the study was hospital stay, ICU stay, and 24 h mortality. Statistical Analysis: The sensitivity, specificity, positive predictive value, negative predictive value, odds ratio, positive likelihood ratio, and negative likelihood ratio of SI and MSI were evaluated using Graphpad software. ROC curves and scatter diagrams were also plotted. Results: SI >0.9 has a sensitivity of 96% and a negative predictive value (NPV) of 93.75%. Similarly, MSI >1.3 has a sensitivity of 96% and NPV of 94.12%. Statistically, a significant correlation was observed between SI & MSI with ISS, ICU stay, and hospital stay. Conclusion: SI and MSI are effective predictors of 24 h mortality but less efficient in predicting mortality that does not occur before 24 h. Higher SI & MSI values are related to higher ISS, and longer duration of ICU & hospital stays.
Telemedicine in Handling Medical Emergencies in India: Exploring Hidden Potential of Current Health Infrastructure
Authors:   Department of Pharmacology, Al Falah School of Medical Science & Research Centre, Dhauj, Faridabad Haryana 121004,, Gupta Pankaj Kumar , Garima Gini ,   Department of Biochemistry, ESIC Medical College & Hospital, Faridabad, Haryana 121001, India.
Published: January 2024

India is one of the most populous countries and is moving towards providing easily accessible and affordable health care to its citizens. In recent times, it has witnessed a transformation of emergency ambulance services which has saved more than a million lives in its urban and rural areas. The COVID-19 pandemic has provided a unique opportunity to strengthen its healthcare infrastructures. MOHFW legalized telemedicine in India in March 2020 which has provided an opportunity for doctors to provide consultation to patients who is in remote part of the country and for rural patients, getting consultation from specialists of choice from their homes. Recently, there has been a lot of focus on emergency medicine and NMC reforms made it mandatory for medical colleges to have a separate unit for this specialty. There is a need to combine telemedicine with emergency medical care in India as India is facing more than 2 million medical emergencies every year and in many cases, emergency medical care is needed immediately in the form of first aid advice and/or counseling to prevent possible complications. India has one of the world’s highest internet users, as well as India, has one of the world’s highest numbers of medical institutions which are producing more than 80,000 medical graduates every year. Now a day, India is witnessing growth in its telemedicine platforms available to its citizens. In moving next to strengthen its health infrastructure, all these dots can be combined effectively to create an ecosystem for dealing with medical emergencies via telemedicine.
Comparison of Point of Care Versus Laboratory Autoanalyzer Measurements of Sodium and Potassium Levels in Patients Admitted from the Emergency Department
Authors:   Associate Cunsoltant, Institute of Emergency Medicine & Trauma Center, Course Site Director-MEM., Khan Imran Ahmad , Nomani Sajid N A ,   Consultant & Director, Institute of Emergency Medicine & Trauma Center, Course Site Director-MEM., Mishra Debasish ,   Associate Cunsoltant, Institute of Emergency Medicine & Trauma Center, Course Site Director-MEM., Yadav Amit ,   Associate Cunsoltant, Institute of Emergency Medicine & Trauma Center, Course Site Director-MEM., Sarkar Sayantika ,   Junior Consultant, Department of Emergency Medicine, AMRI Hospital, Bhubaneswar 751030, Odisha, India., Patnaik Sonal ,   Junior Consultant, Department of Emergency Medicine, AMRI Hospital, Bhubaneswar 751030, Odisha, India.
Published: January 2024

Electrolyte problems are one of the most common cause of morbidity and mortality in the sick patients coming to the Emergency. Electrolytes measured in central lab usually takes 30-60 minutes or more whereas point of care device can give results within 5 to 10 minutes, however different instruments available and their values varies accordingly. Therefore, this study was done to investigate whether electrolyte i.e. sodium and potassium levels assessed using point of care device and auto analysers were equivalent. Methods: We prospectively studied patients admitted from Emergency Department between January 2021 to October 2021. We had taken 60 paired convenience samples and analysed sodium and potassium levels in point of care device (epoc POC device, Siemens) and in Central Lab Auto Analyser (Siemens Dimension RxL Max Integrated chemistry analyzer or in Johnson & Johnson chemistry analyser model number 51 FS). Statistical method to compare the data included Boxplot view, Regression line, Spearman’s correlation coefficient’s, paired t-test for potassium and Wilcox test for sodium correlation, Regression equation, Deming regression and Bland Altman plots.
Penile Paraffinoma, A Disastrous Effect of a Failed Self inflicted Penile Augmentation Technique
Authors:   Specialty, Department of Emergency Medicine, East Kent Hospitals NHS Trust, UK., Naidu Sarat , Hemdev Vaishnavi ,   Third Year MBBS Student, Department of Emergency Medicine, University of Central Lancashire (UCLAN), UK., Concessao Elvin ,   Specialty, Department of Emergency Medicine, East Kent Hospitals NHS Trust, UK.
Published: January 2024

Penile paraffinoma is a rare cause of penile lump(s) or mass that occurs after self- injecting liquid paraffin or similar substances like vaseline, mineral oils, illicitly performed to augment penis growth. This practice is commonly seen in many parts of central and south east Europe and some parts of Asia like Korea. Although paraffin is an inert substance for human body tissue, it can often cause complications like nodules, lumps, ulcers, pain, deformity etc. when injected into human body. The purpose of this study is to present a case of anadverse consequence of a failed penile augmentation technique that required surgical reconstruction.
Acute Abdominal Presentation in Emergency and a Prodigious Diagnosis of Acute Epiploic Appendagitis: A Rare Case Report
Authors:   Specialty doctor, Department of Accident & Emergency Medicine, Weston General Hospital, University Hospital Bristol & Weston, NHS Foundation Trust, Weston Super Mare, North Somerset, UK., Banerjee Sayani , Quadri Tehseen ,   Consultant, Department of Accident & Emergency Medicine, Weston General Hospital, University Hospital Bristol & Weston, NHS Foundation Trust, Weston Super Mare, North Somerset, UK.
Published: January 2024

Background: Appendices Epiploicae, also referred as Epiploic appendages, are 50-100 fat filled finger like projection from the serosal surface of large intestine. Epiploic Appendagitis is a self-limiting, benign disease process which results from the inflammation of these Appendices Epiplocae or thrombosis of the draining vein of Appendices Epiplocae. Case Report: We report a case of 49 year old female, generally well, presented to the A & E with complaints of a painful lump in her left iliac fossa growing in size for last four weeks. She presented to us because of acute increase in size and pain, resulting in significant discomfort. Owing to her history of CIN-1 we arranged a CT abdomen and pelvis with contrast fearing some sinister underlying ongoing pathology causing her symptoms. But to our surprise Ct reported a underrated cause of her abdominal pain, Epiploic Appendagitis. We were surprised of her presentation as a hard abdominal lump which was quite unusual for EA to present as. We assume it was secondary to an extensive underlying local inflammatory reaction. Patient was reassured and treated with NSAID, antibiotics and follow up with surgery ambulatory care. Conclusion: We authors are reporting this case of primary epiploic appendagitis because we think every emergency and primary care physicians should be aware of this very rare condition which might present to emergency as an acute abdominal presentation mimicking other common presentations like acute diverticulitis and acute appendicitis. Being aware of this condition is utmost important to diagnose it early and avoid more invasive surgical managements and unnecessary antibiotic usage.
Left Upper Limb Deep Venous Thrombosis: A Rare Condition Becoming Common Nowadays
Authors:   Emergency Medicine Resident, Department of Emergency Medicine Max Hospital, Shalimar Bagh 110088, New Delhi, India., Mitra Manas , Rajpal Bhumika ,   Emergency Medicine Resident, Department of Emergency Medicine Max Hospital, Shalimar Bagh 110088, New Delhi, India., Kaushik Arun ,   Associate Consultant,Department of Emergency Medicine Max Hospital, Shalimar Bagh 110088, New Delhi, India., Datta Kishalay ,   Director and HOD, Department of Emergency Medicine Max Hospital, Shalimar Bagh 110088, New Delhi, India.
Published: January 2024

Deep venous thrombosis of the upper limb is a less common phenomenon than lower limb deep vein thrombosis. The commonest reasons are trauma secondary to sport or job related arm movements and arm positions, predisposing for upper limb deep venous thrombosis. In this case report, we will discuss the diagnosis and management of upper limbs deep vein thrombosis, along with review of literature.
Cauda Equina Syndrome and the Adolescent Patient with Low Back Pain: A Case Report
Authors:   Consultant, Department of Emergency Medicine, Holy Family Hospital, Mumbai 400050, Maharashtra, India., Vajifdar Farzin , Pavrey Renaldo ,   Senior Consultant, Emergency Medicine, Nanavati Max Centre for Accident & Emergency Medicine, NMSSH Mumbai 400056, Mahrashtra, India.
Published: January 2024

Low back pain is a common complaint in adults of all ages, and is being increasingly seen in children and adolescents. The lifetime occurrence of low back pain is around 59%.1 Mechanical low back pain is globally one of the most common presentations seen by the Emergency Physician.14 Most cases of low back pain treated in the Emergency Department (ED) are not true emergencies, a notable exception being the Cauda Equina Syndrome (CES). Owing to the low occurrence and low index of suspicion in the pediatric/adolescent age group, there may be a significant delay in diagnosis of Cauda Equina Syndrome. This is concerning, because delay in diagnosis and there by treatment, runs the risk of permanent neurological damage and disability. Unequivocally, the most common predictor of a favourable outcome in CES is early diagnosis. We present the case of a 16-year-old male who presented to the ED on three separate occasions complaining of low back pain. The patient had red flag signs during the second visit; however, the relevant history and clinical findings were not elicited at the time. On the third ED visit, a clinical diagnosis of CES was made and urgent magnetic resonance imaging of the lumbo-sacral spine revealed a large right para-central herniation of the L4-L5 disc indenting the right L5 nerve root. Our aim in highlighting this case is two fold: 1. To make the Emergency Physician aware of the rare diagnosis of CES in this uncommon age group. 2. To stress the importance of early recognition of red flag signs in CES which will lead to an early diagnosis, and thereby a favourable outcome.
Postpartum Seizure Disorder
Authors:   First Year MEM Resident, Department of Emergency Medicine, Max Super Speciality Hospital, Shalimar Bagh 110088, Delhi, India., Rajpal Bhumika , Mitra Manas ,   First Year MEM Resident, Department of Emergency Medicine, Max Super Speciality Hospital, Shalimar Bagh 110088, Delhi, India., Rawat Anita ,   Senior Consultant,Department of Emergency Medicine, Max Super Speciality Hospital, Shalimar Bagh 110088, Delhi, India., Datta Kishalay ,   Director and HOD, Department of Emergency Medicine, Max Super Speciality Hospital, Shalimar Bagh 110088, Delhi, India.
Published: January 2024

Eclampsia and severe pre-eclampsia are usually rare, but potentially life threatening medical disorders that the emergency physicians should diagnose and treat promptly. In this case report, we discuss a young female with generalized tonic clonic seizure in the postpartum period, the diagnosis and management in the emergency department of our hospital along with review of literature.
The Adult! Blue Baby
Authors:   Consultant and Head, Department of Emergency Medicine, Zydus Hospitals, Ahmedabad 380054, Gujarat, India., Patel Ketan D , Patel Rignesh ,   Consultant, Department of Emergency Medicine, Zydus Hospitals, Ahmedabad 380054, Gujarat, India., Patel Shikha ,   Resident, Department of Emergency Medicine, Zydus Hospitals, Ahmedabad 380054, Gujarat, India., Sutariya Jay ,   Resident, Department of Emergency Medicine, Zydus Hospitals, Ahmedabad 380054, Gujarat, India., Jhala Heer ,   Resident, Department of Emergency Medicine, Zydus Hospitals, Ahmedabad 380054, Gujarat, India.
Published: January 2024

Central cyanosis is common clinical presentation in neonates and infants which is highly associated with congenital heart diseases (CHD) but this presentation is very unusual in adults presenting only with fever. However, thinking of central cyanosis in adults can lead us to variety of causes ranging from pulmonary embolism to valvular heart defects as well as arteriovenous malformation and poisoning. Through clinical evaluation and point of care echocardiography gives the insight of unusual diagnosis.
Muscle Injury Due to Vigorous Heavy Weightlifting
Authors:   Emergency Medicine Resident, Department of Emergency Medicine, Max Super Speciality Hospital, Shalimar Bagh 110088, Delhi, India., Mitra Manas , Rajpal Bhumika ,   Emergency Medicine Resident, Department of Emergency Medicine, Max Super Speciality Hospital, Shalimar Bagh 110088, Delhi, India., Rawat Anita ,   Senior Consultant, Department of Emergency Medicine, Max Super Speciality Hospital, Shalimar Bagh 110088, Delhi, India., Datta Kishalay ,   Director and HOD, Department of Emergency Medicine, Max Super Speciality Hospital, Shalimar Bagh 110088, Delhi, India.
Published: January 2024

Rhabdomyolysis is a life threatening condition with various end organ damage like acute kidney injury, disseminated intravascular coagulation and others. In this case report, we discuss a patient who presented to the Emergency department after developing severe right gluteal and lower limb pain after having a weightlifting session, the diagnosis and management.
Comparision Between Provisional Diagnosis made in Emergency Department vs Final Discharge Diagnosis at Ramkrishna Care Hospital, Raipur C.G
Authors:   MEM resident 3rd year, Department of Emergency Medicine, Ramkrishna Care Hospital, Raipur 492001, Chattisgarh, India., Nandy Aishwarya , Singh Santosh Kumar ,   Head of Department, Department of Emergency Medicine, Ramkrishna Care Hospital, Raipur 492001, Chattisgarh, India., Vaja Uvesh ,   Senior Consultant, Department of Emergency Medicine, Ramkrishna Care Hospital, Raipur 492001, Chattisgarh, India.
Published: January 2024

Objective/Hypothesis: Objective of this study was to find out the diagnostic accuracy made by emergency physician, this will ensure improvement in patients care and will help to implement better accuracy in determining diagnostic accuracy. Background: Department of emergency medicine is a specialized care facility in tertiary health care centre whose main function is to take care of patients with immediate and emergent health issues. In view limited literature in EM in India a study between PD vs FD was performed for future reference in continuous quality improvement. Methods: A prospective, observational study was done among 200 patients between provisonal diagnosis made in emergency department vs final discharge diagnosis. Results: Majority of the patients (n=153, 76.5%) were from the age group of patients between 15-64 followed by (n=40, 20%) in the age group with patients of >65 years age, followed by (n= 7, 3.5%) in the age group of 1-14 years. Most matched diagnosis were from department of internal medicine (18.5%) followed by department of cardiology (16%), followed by department of neuromedicine (13%). It was found that 81% (n=162) cases were accurately matched) diagnosed during Emergency department admission, while there was unmatched diagnosis of 19% cases (n=38). Conclusion: Result obtained suggests that the provisional diagnosis was made by the emergency physicians were mostly matched with final discharge diagnosis that was made by the concerned specialist doctors. This shows that the choice of treatment done in the ER were a prompt and accurate treatment. This has a positive effect on the prognosis, mortality and outcome in patients. Department of internal medicine had more diagnostic errors. Improving history taking of patients with proper clinical evaluation correct diagnosis in the ER. Early availability in blood reports during emergency stay will help as a better diagnostic interpretation of disease. it is required to upgrade clinical skills of emergency physicians in diagnosing pediatric age group.
Case Report on a Cocktail Drug Abuser Developing Rhabdomyolysis
Authors:   Post Graduation 3rd Year Resident, Department of Emergency, Max Smart Superspecially Hospital, Saket 110017, Delhi, India., Prateek Domadala Sai , Palta Kamal Preet ,   Senior Consultant Head of Department, Department of Emergency, Max Smart Superspecially Hospital, Saket 110017, Delhi, India., Roy Bibhash ,   Consultant, Department of Emergency, Max Smart Superspecially Hospital, Saket 110017, Delhi, India.
Published: January 2024

Rhabdomyolysis is a medical emergency characterized by the break down of skeletal muscle leading to the release of intracellular contents into the blood stream, which can lead to acute kidney injury and even death. Drug abuse is one of the potential causes of rhabdomyolysis. This case report describes a 18-year-old male with a history of drug abuse who presented to the emergency department with severe muscle pain, weakness, dark and reduced amount of urine. The patient was diagnosed with rhabdomyolysis, which was likely due to a combination of high doses Marijuana, Chlorpheniramine, Dextromethorphan (Corex Syrup), Dicyclomine, Tramadol, Acetaminophen and cigarette smoking over period of 4-5 years, landed up in rhabdomyolysis after joining gym. The patient was immediately started on aggressive intravenous fluid resuscitation, and his urine output and electrolyte levels were closely monitored. Patient required initiation of Hemodialysis over period of 15 days. Patient's muscle pain and weakness gradually improved over the next few days, and he was discharged with a diagnosis of AKI due to Rhabdomyolysis due to drug abuse. Prompt recognition and treatment of rhabdomyolysis are crucial to prevent serious complications, and addiction treatment should be pursued to prevent future episodes of rhabdomyolysis and other drugrelated complications.
Refractory Hypoglycemia with Generalized Convulsive Status Epilepticus in Suspected Propranolol Overdose: Is Early Intubation the Key?
Authors:   Senior Consultant & Head, Department of Accident and Emergency Medicine, Nanavati Max Super Speciality Hospital, Mumbai 400056, Maharashtra, India., Pavrey Renaldo ,   Consultant, Department of Accident and Emergency Medicine, Nanavati Max Super Speciality Hospital, Mumbai 400056, Maharashtra, India., Das Nisha , Raj Sonal ,   Resident, Department of Accident and Emergency Medicine, Nanavati Max Super Speciality Hospital, Mumbai 400056, Maharashtra, India., Altamas Mohammad ,   Resident, Department of Accident and Emergency Medicine, Nanavati Max Super Speciality Hospital, Mumbai 400056, Maharashtra, India.
Published: January 2024

There are many ways to manage status epilepticus. The rationale for aggressive treatment of generalized convulsive status epilepticus lies solely on the premise that best outcomes rely upon rapid seizure control. Metabolic and toxic seizures can be particularly refractory to therapy, exposing a patient to the threat of aspiration, hyperkalemia, rhabdomyolysis, hyperthermia, myocardial infarction, and arrhythmias.1 The role of intubation is controversial. Neurologists tend to view intubation as a form of “treatment failure”, reflecting inability to treat the seizure with traditional agents.1 However, it is our opinion that intubation is often the key therapeutic intervention to not only control the seizure, but prevent its deadly complications. In our case report, we highlight the emergent airway management of a 29-year-old pre-morbidly healthy female who was referred to us from a secondary care center with generalized convulsive status epilepticus and refractory hypoglycemia, following an alleged history of propranolol overdose.
Awareness and Screening for Cervical Cancer using Papanicolaou Smear Test Among Women in A Rural Area
Authors:   Junior Resident, Department of Obstetrics & Gynecology, Ganni Subba Lakshmi Medical College, Rajahmundry 533296, Andhra Pradesh, India., Jyothi Kiranam Balaga , Naga Lakshmi K ,   Junior Resident, Department of Obstetrics & Gynecology, Ganni Subba Lakshmi Medical College, Rajahmundry 533296, Andhra Pradesh, India., Annapoorna Y ,   Professor, Department of Obstetrics & Gynecology, Ganni Subba Lakshmi Medical College, Rajahmundry 533296, Andhra Pradesh, India.
Published: January 2024

ackground: Cervical cancer is one of the most common cancers among women Worldwide and the leading cause of cancer mortality in women in India. Objective: The objective of this study is to assess the knowledge of cancer cervix and the practice of Pap smear test among women in a rural area. Methods: The awareness and screening for cancer cervix using Papanicolaou smear test among women were studied in 526 women at 9 different health centers in a rural area near Rajahmundry from March 5th, 2021 to March 10th, 2021 with a questionnaire survey of history, assessment of knowledge about cancer cervix, attitude and practice of Pap smear testing & HPV vaccination followed by clinical examination and screening using pap smear test. Results: During the study period, a total of 526 women were surveyed, out of which screening was done in only 394 women. Most of the women belong to 30-39 years (37.2%). Distribution of the women based on socio-economic class, occupation, parity, symptoms, clinical examination, knowledge about cervical cancer, and the results of pap smear tests were also studied out of which vaginal discharge seems to be the most common symptom (15.2%), the cervical examination was normal in 91.6%, 77.3% had awareness about cancer cervix and 41.4% of participants had adequate knowledge about Pap smear test. Conclusion: Awareness about cancer cervix was adequate but the awareness & the rates of pap smear testing and HPV vaccination in this area are far lower than in urban areas due to less exposure to health care information.
Low Dose Vaginal Misoprostol in the Mangement of Intrauterine Fetal Death: Two Years Retrospective Study at Navodaya Medical College, Raichur
Authors:   Professor and HOD, Department of Obstetrics and Gynecology, Navodaya Medical College, Raichur, Karnataka 584103, India., D Rita , Himaja V ,   Junior Resident, Department of Obstetrics and Gynecology, Navodaya Medical College, Raichur, Karnataka 584103, India.
Published: January 2024

Introduction: Management of intrauterine fetal death (IUFD) poses dilemma for obstetrician.1 Options for health care are either to await for spontaneous labour or to induce labour.2 Medical consequences of postponing delivery can be significant in view of complications like disseminated intravascular coagulopathy or haemorrhage and even maternal death. Aims and Objectives: To evaluate effectiveness and side effects of repeated vaginal administration of small doses of misoprostol in termination of second and third trimester pregnancies.1 Methods: This study carried out on 100 women with IUFD in second and third trimester pregnancies collected from NMC Medical college, RAICHUR, from October 2017 to October 2019. Patients history taken, physical examination, Bishop scoring assessed. 25µg of misoprostol in the posterior fornix of vagina was placed every 4th hourly over 24 hours. The progress, and outcomes were assessed. Results: The success rate was 92.76% and 64.52% in women with third and second trimesters respectively. The mean induction-delivery interval was 15.67+9.64 and 24.94+8.23. The induction delivery interval correlated negatively with the duration of gestation age. The mean value x of total required dose of misoprostol was 192.42 +128.99 and 361.29 + 139.92 for 2nd trimester and 3rd trimester women. Conclusion: Low dose Misoprostol appears safe, effective, practical and inexpensive method for termination of third trimester pregnancies compared to second trimester pregnancies complicated with Original Research Article Indian Journal of Obstetrics and Gynecology Volume 8 Number 4, October–December 2020 DOI: http://dx.doi.org/10.21088/ijog.2321.1636.8420.7 intrauterine fetal death and its effects increases with duration of gestation.
Comparative Study of Outcomes in Patients Undergoing Laparascopic Assisted Vaginal Hysterectomy and Simple Vaginal Hysterectomy
Authors:   Consultant, Department of Obstetris and gynaecology, Gandhi Medical College, Secunderabad, Andhra Pradesh 500025, India., A Deepika , Avula Krishnaveni ,   Associate Professor, Department of Obstetris and gynaecology, Gandhi Medical College, Secunderabad, Andhra Pradesh 500025, India., Reddy Venkateshwar ,   Retired Professor and HOD, Department of Obstetris and gynaecology, Gandhi Medical College, Secunderabad, Andhra Pradesh 500025, India.
Published: January 2024

Introduction: Hysterectomy can be performed by Abdominal, Vaginal, Laparoscopic and Robotic routes. Aim: Study compares the outcomes of patients undergoing Vaginal hysterectomy with that of Laparoscopic assisted vaginal hysterectomy. Materials and Methodology: This prospective randomized study, was done in the Department of OBG in Gandhi hospital, between February 2014 and July 2015, after ethical committee approval. 50 women underwent Vaginal hysterectomy and another 50 Laparascopic assisted Vaginal Hysterectomy. Parameters like Age, Parity, BMI, History of Previous Caesarean, Medical illnesses like Hypertension and Diabetes, Uterine size, Indication for Hysterectomy, Operating time, blood loss, visceral injury, Postoperative fever, Urinary tract infection, Fall in Haemoglobin, Blood transfusions, Pain on day three, Day of Ambulation and Hospital stay were studied. Statistical analysis was done between the two groups on the parameters, using Chi-square test for qualitative parameters and Student “t” for quantitative variances. Results: There was no gross discrepancy in the “Mean value” in two groups regarding the above studied parameters, excepting the Operating time, which was almost double in Laparoscopic assisted vaginal hysterectomy. Indications constituted the same for both the groups. Discussion: “P’ value was insignificant in relation to age, parity, BMI, Previous Caesareans, medical illnesses, uterine volume, blood loss, fall in hemoglobin, blood transfusions, visceral injuries, postoperative fever, UTI, Pain, and day of ambulation. Indications for hysterectomy are comparable with other studies. The “P” value was significant for the operation time. Conclusions: Operating time is less in SVH. LAVH has higher complication rate. Key words: Simple Vaginal Hysterectom (SVH); Laparoscopic Assisted Vaginal Hysterectomy (LAVH); Intra Operative Outcomes; Postoperative Outcomes; Demographic Data; Operating Time; Visceral Injuries.
Clinico-Pathological Study of 100 Hysterectomies
Authors:   Doctor, Shraddha Hospital, opposite BDO office, Mumbai-Goa highway, Chiplun, District Ratnagiri, Maharashtra 415605, India., Vijay Reelkar Purva , Vitthal Reelkar Vijay ,   Doctor, Shraddha Hospital, opposite BDO office, Mumbai-Goa highway, Chiplun, District Ratnagiri, Maharashtra 415605, India.
Published: January 2024

Background: Uterus is a very vital reproductive organ and is subjected to many benign and malignant diseases. Hysterectomy is one of the most frequently performed procedures all over the world. This is a retrospective study to evaluate the sensitivity between the indications, demographic features, clinical presentations, intra operative findings and histopathological diagnosis of patients who underwent hysterectomy. Methods: This study was conducted in the Shraddha hospital, Chiplun, Maharashtra, India. 100 patients were selected randomly. Data was recorded and analyzed from the case record of each patient, which was obtained from the medical record department of the hospital. Results: Abdominal hysterectomy was performed in 84% cases while vaginal hysterectomy accounted for 16% cases. The mean age for hysterectomy was 45 years with a range from 31 to 70 years. (Table no 1) Patients mostly presented with menstrual complaints i.e. menorrhagia and dysmenorrhoea (62%) followed by prolapse uterus (16%). (Table no 2) The principle indication of elective hysterectomy was leiomyoma and was present in 37% patients, followed bydysfunctional uterine bleeding (DUB) in 28 % patientsand prolapse uterus in 16%. (Table no 3)Maximum numbers of cases of leiomyoma and DUB were found in age group of 41-50 yrs. Postoperatively nausea and vomiting was experienced by 31.5% of patients, whereas 22.8% of the patients had urinary tract infection. No major post operative complications were observed. Conclusion The number of abdominal hysterectomy was more than vaginal hysterectomy. Most common presenting feature was menstrual related symptom followed by prolapsed. The main indication for elective hysterectomy was leiomyoma, prolapsed and DUB. Keywords: Hysterectomy; Menorrhagia; DUB; Leiomyoma; Prolapse.
Ruptured Cornual 20 weeks Pregnancy with Fetal Demise with Fetus in Abdominal Cavity with Gross Haemoperitoneum with Severe Anaemia
Authors:   Gynecologist, Department of gynecology, Smt Jaidevi Memorial Nursing Hospital, Sonipat 131001, Haryana, India., Dahiya Vijeta
Published: January 2024

Ectopic pregnancy is the most life threatening emergency in pregnancy and common cause of morbidity and mortality in first trimester of pregnancy. 23 Yrs old female presented with history of 5 months amenorrhoea with slight bleeding per vaginum. Patient is primigravida. On Per abdomen examination, abdomen was tense. On USG Diagnosis, it was clear and the patient was taken for Laprotomy and the patient stood up the procedure well.
A Case Report on Silent Scar Dehiscence in a Patient with Previous Transverse Cesarean Section
Authors:   Post Graduate, Department of Obstetrics and Gynecology, Vinayaka Missions Medical College, Keezhakasakudy, Karaikal, Pondicherry 609609, India., VC Veena , NS Narmadha ,   Senior Resident, Department of Obstetrics and Gynecology, Vinayaka Missions Medical College, Keezhakasakudy, Karaikal, Pondicherry 609609, India.
Published: January 2024

Introduction: Cesarean section is the delivery of an infant (live or dead) through an abdominal incision after the period of viability. An incomplete uterine rupture, also referred to as uterine dehiscence, is defined as a clinically occult and incomplete disruption that does not lead to any serious neonatal or maternal consequences. Case report: This is a case report of a pregnant women with previous 1 cesarean section, with silent scar dehiscence found accidental on repeat cesarean section, and its successful management during the procedure. Conclusion: Uterine scar dehiscence when detected early can be prevented from progressing further to scar rupture. Prompt decision making and skilled surgical repair may aid in reducing the incidence of such complications. Keywords: Incomplete uterine rupture; Silent Scar dehiscence; Cesarean section.
Pregnancy after Tubal Sterilization
Authors:   Resident, Department of Obstetrics and Gynecology, GSL Medical College, Rajahmundry, Andhra Pradesh 533296, India., Akshara P , Sonica Vattikuti ,   Resident, Department of Obstetrics and Gynecology, GSL Medical College, Rajahmundry, Andhra Pradesh 533296, India., Annapoorna Y ,   Professor, Department of Obstetrics and Gynecology, GSL Medical College, Rajahmundry, Andhra Pradesh 533296, India.
Published: January 2024

Objectives: In our study, we have tried to evaluate the causative factors for sterilization failure and also to discuss preventive measures to avoid maternal morbidities and unwanted pregnancies and as a result of sterilization failure especially in developing countries like India and tried to establish methods to decrease the rates of failed sterilization. Materials and Methods: This study is a retrospective study that was done on all the women presented with failed sterilization in the Department of obstetrics and gynaecology, GSL medical college and general hospital from May 2018 to May 2019. Results: During 1 year 20 cases of post-sterilization failure were reported, out of which 16 (80%) cases were intra-uterine pregnancies and 4 (20%) were ectopic pregnancies. Among which 17 (85%) cases underwent sterilization by modified Pomeroy’s method & 3(15%) underwent laparoscopic sterilization.14 (70%) cases presented to opd within 12 wks of gestation, out of which 2 cases (10%) underwent first trimester MTP.10 (50%)cases delivered at term by normal vaginal delivery, 1case delivered as preterm & 4 (20%) delivered at term by elective cesarean section. 7 cases underwent resterilisation by fimbriectomy & 13 cases underwent sterilization by bilateral salpingectomy. Conclusion: In the present study open method of sterilization was the most common cause of post sterilization failure than laparoscopic sterilization. Conversely, sterilization failure after one year is more likely due to natural tubal lumen regeneration through tubal recanalization or fistula formation. Hence proper counselling before sterilization should be done regarding the procedure, failure rates and morbidity. Surgical procedures should document Intra-operative adhesions, difficulty in identifying tubes, slipped rings or bands. Despite few failure rates tubal sterilization remains the most chosen method to control the population.
Gastric Outlet Obstructions and its Management in a Tertiary Care Hospital
Authors:   Assistant professor, Department of General Surgery, Subbaiah Institute of Medical Sciences, Shivamogga, Karnataka 577222, K Prasad , Krishnaveni Gudla ,   Surgical Resident, Department of General Surgery, Sahyadri Narayana Multi-speciality Hospital, Shivamogga, Karnataka, 577222, India., BP Suresh ,   Professor and HOD, Department of General Surgery, Subbaiah Institute of Medical Sciences, Shivamogga, Karnataka 577222,
Published: January 2024

Background: Gastric Outlet Obstruction may be caused by a heterogeneous group of diseases that include both benign and malignant conditions. In adults, mechanical obstruction due to ulcers, tumors or gastric polyps are common causes of gastric outlet obstruction. Until introduction of effective ulcer therapy duodenal ulcer was the commonest cause of gastric outlet obstruction and malignancy was attributed to only 20% of the cases. Objectives: To study the modes and presentation of presentation of gastric outlet obstruction among patients suffering from Duodenal ulcer diseases. Materials and Methods: A Hospital based Prospective study was conducted at Tertiary Care Centrefrom October 2017 to September 2019. A total of 100 cases of Gastric outlet obstruction were diagnosed during the study period. An elaborate study of these cases with regard to the history, clinical features, routine and special investigations, pre-operative treatment, operative findings, postoperative management and complications in post-operative period is done. Results: A total of 100 cases with gastric outlet obstruction were analyzed in our study. Out of the 100 cases with gastric outlet obstruction, 28 (28%) were diagnosed with cicatrizes duodenal ulcer and 72 (72%) of them had carcinoma antrum. Majority of the study subjects presented with pain, vomiting and anorexia on admission. Pallor was seen in nearly 68% of the study subjects followed by 56% of the cases with VGP and 54% with succession Splash. Only 28% of the subjects had palpable mass on palpation. Conclusion: Upper Gastro intestinal endoscopy should be mandatory in all suspected cases of gastric outlet obstruction. It can diagnose the cause of obstruction very effectively than any other investigative modality. Effective treatment in carcinoma stomach depends on early diagnosis.
Prevalence of Common Upper GI Diseases on Esophagogastroduodenoscopy
Authors:   Assistant professor, Department of General Surgery, Subbaiah Institute of Medical Sciences, Shivamogga, Karnataka 577222, India., K Prasad , S Pavan Kumar ,   Assistant professor, Department of General Surgery, Subbaiah Institute of Medical Sciences, Shivamogga, Karnataka 577222, India., BP Suresh ,   Professor and HOD, Department of General Surgery, Subbaiah Institute of Medical Sciences, Shivamogga, Karnataka 577222, India.
Published: January 2024

Objective: To document and correlate different indications and findings of EGD scopyin our endoscopy unit. Methods: A retrospective descriptive study of 519 patients who underwent Esophagogastro duodenoscopy (EGD scopy) was conducted in the Endoscopy Unit of Department of General surgery of Tertiary Care Centre. Included patients underwent EGD scopy. Demographic data including indications and endoscopic findings of the patients were collected via study proforma. Results: Total five hundred and nineteen patients were studied; Out of all 64.54% were males and 35.06% were females. Epigastric pain or pain abdomen was the commonest indication (41.23%) followed by dysphagia (13.48%), Hematemesis (10%), vomiting and regurgitation, screening (9.05% and 7.51% respectively). The most common endoscopic findings were gastritis (35.45%), GERD (9.82%), Varices (9.02%), Carcinoma (7.32%), GI Ulcer (5.78%), hiatal hernia (5.58%), stricture (3.08%) and normal (20.03%). Conclusion: The most common indication was Epigastric pain or pain abdomen for EGD scopy and indications were relevant to findings.
Long Standing Intercostal Drainage a Boon or a Curse: Our Experience
Authors:   Senior resident, Department of Plastic Surgery, Jawaharlal Institute of Postgraduate Medical Education & Research, Pondicherry, 605006, India., Reddy K Sri Harsha , Chittoria Ravi Kumar ,   Professor & Registrar, Department of Plastic Surgery, Jawaharlal Institute of Postgraduate Medical Education & Research, Pondicherry, 605006, India., K Nishad ,   Senior resident, Department of Plastic Surgery, Jawaharlal Institute of Postgraduate Medical Education & Research, Pondicherry, 605006, India., Thomas Neljo ,   Senior resident, Department of Plastic Surgery, Jawaharlal Institute of Postgraduate Medical Education & Research, Pondicherry, 605006, India.
Published: January 2024

Seroma, wound infection, skin flap necrosis, nipple necrosis (after nipple-areolar sparing mastectomy [NSM]), are all complications of mastectomy. ICDs (intercostal chest drains) are frequently employed in medical, surgical, and critical care settings. Incorrect placement or management of intercostal chest drains can lead to significant morbidity and even mortality. The risk of acquired infection is directly proportional to the duration of ICD placement in-situ. For patients with sepsis and septic shock, therapeutic priorities include securing the airway (endotracheal intubation and mechanical ventilation), correcting hypoxemia, and establishing vascular access for the early administration of fluids and antibiotics. Hence, ICD tubes that are kept in-situ for a long duration must be managed according to the approved guidelines by qualified personnel and under adequate supervision.
Outcome among Patients undergoing open Fistulectomy and Fistulectomy with Primary Closure for Low Level Fistula in Ano
Authors:   Assistant professor, Department of General Surgery, Subbaih Institute of Medical Sciences, Shivamogga, Karnataka 577201, K Prasad , Patel Anil Kumar ,   Senior Resident, Department of General Surgery, Shri Shankaracharya Institute of Medical Sciences, Bhilai, Chattisgarh 490 020, India, BP Suresh ,   Professor and HOD, Department of General Surgery, Subbaih Institute of Medical Sciences, Shivamogga, Karnataka 577201
Published: January 2024

To document and correlate different indications and findings of EGD scopy in our endoscopy unit. Methods: A retrospective descriptive study of 519 patients who underwent Esophhago gastroduodenoscopy (EGD scopy) was conducted in the Endoscopy Unit of Department of General surgery of Subbaih Institute of medical sciences, Shivamogga. Included patients underwent EGD scopy. Demographic data including indications and endoscopic findings of the patients were collected via study proforma. Results: Total five hundred and nineteen patients were studied; Out of all 64.54% were males and 35.06% were females. Epigastric pain or pain abdomen was the commonest indication (41.23%) followed by dysphagia (13.48%), Hematemesis (10%), vomiting and regurgitation, screening (9.05% and 7.51%respectively). The most common endoscopic findings were gastritis (35.45%), GERD (9.82%), Varices (9.02%), Carcinoma (7.32%), GI Ulcer (5.78%), hiatal hernia (5.58%), stricture (3.08%) and normal (20.03%). Conclusion: The most common indication was Epigastric pain or pain abdomen for EGD scopy and indications were relevant to the findings. Keywords: Esophhago Gastroduodenoscopy; Endoscopy; Upper GI diseases; Acidity.