bluuebunny/crossref_metadata_2025 huggingface dataset:
Radiological approach for early diagnosis of liver parenchymal disease
Authors: Rachna Chaurasia  , Sunil
Published: January 2025

Background: Diffuse liver parenchymal disease (LPD) encompasses a wide range of liver disorders characterized by extensive involvement of liver tissue, often resulting in significant morbidity and mortality. Early detection and accurate assessment of these diseases are crucial for effective management and improved patient outcomes.
Aims and Objectives: This study aims to evaluate the efficacy of various imaging modalities in the early detection and monitoring of diffuse LPDs, specifically focusing on non-invasive techniques such as ultrasonography (USG), computed tomography (CT), and Fibroscan.
Materials and Methods: A prospective observational study was conducted involving 362 patients presenting with clinical signs and symptoms of liver disease at Maharani Laxmi Bai Medical College, Jhansi. Patients underwent standardized imaging protocols, including US, CT, and Fibroscan, along with laboratory tests to confirm liver function abnormalities. Imaging findings were correlated with clinical and laboratory data to assess diagnostic accuracy and efficacy.
Results: The study found that ultrasound, elastography, and CT provide a reliable, non-invasive method for assessing diffuse LPD at the early stage ultrasound along with Fibroscan and CT both have comparable diagnostic capabilities in assessing diffuse LPD. Ultrasound and Fibroscan being non-invasive and radiation-free should be used as initial investigations whereas CT further contributes to the detailed characterization of liver parenchyma. Integration of these imaging modalities significantly enhanced early diagnosis and disease monitoring.
Conclusion: Integrating advanced imaging modalities, especially elastography, into routine diagnostic protocols for diffuse LPDs enables early detection and effective management. Non-invasive techniques such as US and CT improve patient outcomes by allowing timely intervention and continuous monitoring of disease progression, thus reducing the need for invasive procedures such as liver biopsy.
Laparoscopic management of incisional hernia with special emphasis on intraperitoneal mesh-related complication and advantages over open method
Authors: Pankaj Saunakiya  , Saurabh Purohit  , Jitendra Kumar  , Jatin Chauhan
Published: January 2025

Background: Ventral hernias (VHs) occur as a result of weakness in the musculofascial layer of the anterior abdominal wall. The most popular classification is congenital, acquired, incisional, and traumatic.
Aims and Objectives: The aim of this study is to compare the effectiveness and safety of open versus laparoscopic repair of incisional hernia and to discuss important controversial issues for both procedures, including patient selection, technique, and operative care for laparoscopic repair of VH, operative time of laparoscopic repair of VH, intraoperative and post-operative complications, post-operative pain, post-operative morbidity, and length of hospital stay.
Materials and Methods: This prospective study was done in Maharani Laxmi Bai Medical College; Jhansi between January 2021 and June 2022 including 70 patients of incisional hernia were selected for treatment of hernia repair. Thirty-five patients were subjected to laparoscopic incisional hernia repair and 35 patients were subjected to open incisional hernia repair.
Results: The findings of the present study demonstrate that laparoscopic incisional hernia repair was safe and in comparison with open incisional repair comparatively less intraoperative blood loss, less post-operative pain, less post-operative complication, less hospital stay, early return to normal activity, and less recurrence. The incidence of enterotomy was slightly more in an open method which was found non-significant difference (P≥0.05). Hence, it is concluded that laparoscopic incisional hernia repair should be the procedure of choice.
Conclusions: Laparoscopic incisional hernia repair was safe and better when compared with open incisional hernia repair.
Comparison of Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment intensive care unit scoring system as mortality predictors in intensive care unit patients with sepsis
Authors: Lokesh SB  , Latha V
Published: January 2025

Background: Sepsis is a life-threatening organ dysfunction caused by a deregulated host response to infection. It is one of the leading causes of in-hospital mortality and morbidity among patients. It also results in significant morbidity and financial burden.
Aims and Objectives: (1) To study the etiological profile of patients admitting with sepsis to ICU. (2) To compare between APACHE II and SOFA ICU scoring system of patients with sepsis at admission and at 24 h in predicting the 5th-day mortality.
Materials and Methods: This was a single center hospital based prospective, observational, study conducted in patients in ICUs of ESICMC PGIMSR and Model Hospital Rajajinagar, Bangalore. Patients over age 18 years admitted in ICU who have fulfilled the criteria for sepsis were included in our study. Their clinical profile, APACHE II and SOFA scores were evaluated and followed up to 5th day of admission and data were compared with respect to patients’ outcome in the form of survival.
Results: In this study, out of 53 patients the maximum number of patients belong to the age groups of >60 years (23 patients). Male-to-female distribution in this study noted was 30 and 23 patients, respectively. Aspiration Pneumonitis (17%) and Community-Acquired Pneumonia (17%) were the most common causes of septic. Out of 53 patients, 31 patients did not survive. In this study, it was observed that the SOFA scoring had the highest specificity (87.10%) and APACHE II had the highest sensitivity (96.77%) at admission. However at 24 h of admission, both the highest sensitivity and highest specificity was more for APACHE II score. The most area under the Receiver-operating characteristic curve was better for SOFA score (AUROC=58.0%) at admission than APACHE II score with AUROC of 53.7%, however AUROC of both SOFA and APACHE II score calculated at 24 h of admission were equally good in predicting 5th-day mortality.
Conclusion: We found that the SOFA score outperformed APACHE II scores in predicting survival in septic shock patients at admission. SOFA and APACHE II calculated at 24 h of admission and both scores provided equal efficacy in predicting 5th-day mortality in patients with sepsis.
Awareness, perception and behavioral determinants associated with cancer prevention among adults: Results from a cross-sectional study in urban field practice area of a tertiary care hospital, Kolkata
Authors: Paramita Sarkar  , Pallabi Dasgupta  , Payel Sarkar  , Rivu Basu
Published: January 2025

Background: Cancer is emerging as a major public health problem. Two-thirds of cancer patients are in the advanced stage at the time of diagnosis. Public awareness plays a big role in cancer prevention.
Aims and Objectives: To assess awareness, perception, and behavioral determinants of cancer prevention of urban adults.
Materials and Methods: An observational, cross-sectional study was conducted in the urban slum of Kolkata. Four hundred fifteen respondents were interviewed using a pre-tested questionnaire after having consent.
Results: Though majority (72.3%) of respondents had satisfactory awareness but had limited awareness on screening tests (58.6%) and vaccination (1.6%). Half of them had a favorable perception on cancer prevention but the perceived barrier was more. The behavior score was poor among the majority of participants. The main source of information was T.V. (88.2%) and friends and relatives (80.2%). Only one-fourth of participants mentioned of health workers and health camps as sources of information indicating inadequate activities on cancer awareness programs. Age (OR 7.08, 95% CI=1.07–46.74), sex (OR 0.38, 95% CI=0.19–0.76) education (OR 4.81, 95% CI=2.50–9.27) were significant predictors of satisfactory awareness. Higher levels of education, younger age, and female gender were factors that shaped perception. Only education level (OR 0.29, 95% CI=0.15–0.59) had a significant association with cancer preventive behavior.
Conclusions: Though awareness on primary preventive measures was satisfactory but behavior was unsatisfactory among study participants. They had more perceived barriers while taking preventive measures. The finding indicates a need to promote health education and motivate people to recognize and modify cancer-related behavioral risk factors.
Effect of kangaroo mother care in low-birth-weight babies in reference to breastfeeding in NICU at a tertiary care centre - An observational study
Authors: Dulal Kalita  , Sumana Sarma
Published: January 2025

Background: Kangaroo mother care (KMC) is described by the WHO as early, ongoing, and prolonged skin-to-skin contact between a mother and her preterm infants.
Aims and Objectives: (1) The aim of the study was to study the effect of KMC in growth of newborn and (2) to study the effect of KMC in prevention of hypothermia, apnea, and requirement of prolonged hospital stay.
Materials and Methods: In this prospective, hospital based, observational study, 241 neonates who were hospitalized to the neonatal intensive care unit in Gauhati Medical College and Hospital, Guwahati between April 2023 and March 2024 were assessed. Every potential mother was trained for KMC and given exclusive breastfeeds, and contrasted with a control/(conventional method of care) group of mothers.
Results: The KMC babies had better breastfeeding rates as compared to the control group (76% vs. 53.8%). The weight gain (14.9±4.7 vs. 10.5±4.1 g/day), increase in length (0.97±0.67 vs. 0.69±0.63 cm/week), chest circumference (0.73±0.35 vs. 0.49±0.19 G/week), and head circumference (0.74±0.52 vs. 0.50±0.31 g/week), was also better in the KMC group. The incidence of apnea and hypothermia was significantly less in the KMC group, and the duration of stay in hospital was less in the KMC group than the control group (10±5 vs. 16±8 days).
Conclusions: KMC improves breastfeeding rates, improves growth, reduces morbidities, and decreases duration of hospital stay.
Umbilical port versus epigastric port for gallbladder retrieval in laparoscopic cholecystectomy: An intervention study
Authors: Shakil Jawed  , Shaikh Md Nafis Jahangir  , Imdadul Haque
Published: January 2025

Background: Open cholecystectomy as a routine operation once for cholecystitis and cholelithiasis is no more a routine practice. Laparoscopic cholecystectomy (LC) is one of the most common surgeries done these days and has become the gold standard for the treatment of symptomatic cholelithiasis.
Aims and Objectives: The aim of the study was to compare the retrieval of gallbladder (GB) between epigastric port and umbilical port as two approaches of LC in terms of the time taken to remove GB, pain, and other complications postoperatively.
Materials and Methods: An intervention study was conducted in the general surgery department between June 2022 and May 2023 among 73 patients who were admitted for cholecystectomy recruited by a total consecutive sampling method. Patients were put into two modalities of retrieval of GB by performing the two methods alternately. Templates were generated in MS Excel sheet and analysis was done. Appropriate statistical tests were used and the P<0.05 was taken as significant.
Results: There was no significant difference in the mean age (P=0.21) of patients as well as the mean duration of surgery (P=0.07) through epigastric port as compared to umbilical port. Patients who had undergone retrieval of GB through epigastric port (P=0.04) had significantly lesser pain at 6 h post-operation as compared to epigastric port. The overall pain scores were lesser when extraction of GB was done through epigastric port in comparison with umbilical port. The post-operative complications in terms of infection, hernia was lesser in patients undergoing extraction of GB through epigastric port.
Conclusion: Epigastric port could be better as compared to umbilical port for retrieval of GB with respect to mean duration, post-operative pain and herniation from port site, and also surgical site infection.
Intraperitoneal Bupivacaine 0.25% versus intravenous Diclofenac on post-operative analgesia in the cesarean section under spinal anesthesia: A prospective randomized comparative study in a tertiary care hospital of India
Authors: Pragyanrani Panda  , Imran Ahmed  , Mitesh Kumar Sharma  , Rajesh De
Published: January 2025

Background: Cesarean section (CS) is a common surgical procedure, often accompanied by significant post-operative pain, which can hinder recovery, bonding with the baby, and breastfeeding. Effective pain management is crucial to prevent complications such as chronic pain and depression. Intraperitoneal (IP) instillation of local anesthetics, such as Bupivacaine has shown promise in providing analgesia, while intravenous (IV) Diclofenac is a common alternative.
Aims and Objectives: This study aimed to compare the post-operative analgesic efficacy of IP Bupivacaine with IV Diclofenac in parturients undergoing lower segment CS (LSCS).
Materials and Methods: A randomized, double-blind, prospective study was conducted in Deen Dayal Upadhyay Hospital, New Delhi, with 60 patients divided into two groups: Group B received IP Bupivacaine (30 mL, 0.25%) and Group D received IV Diclofenac (1 mg/kg). Post-operative pain was assessed using the Visual Analog Scale (VAS) at various time points up to 24 h. The time to first rescue analgesia and total analgesic requirement were also measured.
Results: Group B had significantly lower VAS scores at 6, 8, 10, 12, and 24 h post-operatively (P<0.05). Time to first rescue analgesia was longer in Group B (7.26±1.04 h) compared to Group D (5.01±0.49 h) (P=0.001), and the total analgesic requirement was lower in Group B (P=0.01). Early breastfeeding was more feasible in Group B.
Conclusion: IP Bupivacaine provided superior analgesia compared to IV Diclofenac, promoting earlier mobilization, bonding, and breastfeeding. It is a simpler and more effective method for post-operative pain management in LSCS.
A forgotten double J stent with encrustation leading to pelvi-ureteric obstruction: A case report
Authors: Govind Varshney  , Vikram Singh Chauhan  , Ravindra Srivastava  , Purshotam Dass Gupta  , Shilpi Bhattacharya
Published: January 2025

Double J (DJ) ureteric stents are widely applied in urological operations, they maintain patient’s urinary system postoperatively, thereby accelerating recovery. Prolonged stent insertion is associated with complications. A 38-year-old woman presented with hematuria, right flank pain, and urinary tract infection. She underwent renal calculi removal 8 years ago. KUB radiograph revealed and indwelling DJ stent with vesical calculus and pyelonephritis. Ultrasound revealed a large bladder stone with mild right hydronephrosis. Computed tomographic (CT) urography revealed a DJ stent encrustation and further formation into core of the bladder stone. Cystolithotomy was performed, vesicle calculi retrieved. At 4 weeks, the patient presented with a right-side flank pain for which patient was evaluated with a contrast-enhanced CT urography which revealed a pelvi-ureteric junction obstruction with hydronephrosis. A pyeloplasty was performed and DJ stent was placed in situ, to be retrieved at 6 weeks. With improved biomaterials, design and technological improvements of DJ stents, patient’s discomfort is greatly reduced. As a result, DJ stents got left in place for a longer duration of time, and therefore high incidences of forgetfulness, retained DJ stents. Encrustation, however, is frequently encountered. Patient factors such as low education and socioeconomic status and patients living in far off rural places also contribute to forgotten indwelling stents. Authors recommend placement of DJ stents after pyeloplasty for treating pelvi-ureteric junction obstructions following long-term retained stents. Patient counseling, education, and strict follow-up should ensure a timely stent removal and improved patient safety. Effective patient counseling and awareness reduces incidences of forgotten indwelling stents and patient-related complications.
Validation of the P-POSSUM score in predicting outcomes in emergency craniotomy: A prospective observational study
Authors: Hari Prakash Rai  , Shivam Sharma
Published: January 2025

Background: The Portsmouth physiological and operative severity score for the enumeration of mortality and morbidity (P-POSSUM) is an established tool for predicting surgical outcomes. However, its applicability and accuracy in predicting post-operative mortality in patients undergoing emergency craniotomy require further validation.
Aims and Objectives: This study aims to validate the accuracy of the P-POSSUM score in predicting post-operative mortality in patients undergoing emergency craniotomy.
Materials and Methods: A prospective observational study was conducted over 2 years (June 2022–May 2024) at Maharani Laxmi Bai Medical College, Jhansi. Patients undergoing emergency craniotomy were included in the study. Data were collected on pre-operative physiological parameters and intraoperative variables to calculate the P-POSSUM score. The primary outcome was post-operative mortality within 30 days. Statistical analysis involved receiver operating characteristic curve analysis and the Hosmer-Lemeshow test to assess the predictive accuracy and calibration of the P-POSSUM score.
Results: A total of 200 patients were included in the study. The mean age was 53±17 years; 113 were male and 87 were female. The P-POSSUM score demonstrated good predictive accuracy for post-operative mortality with an area under the ROC curve of 0.85 (95% CI: 0.79–0.91). Calibration analysis using the Hosmer–Lemeshow test showed good calibration (P=0.23). Observed mortality was 56 (28%) compared to an expected 61, resulting in an observed-to-expected mortality ratio of 0.92.
Conclusion: The P-POSSUM score is a reliable and accurate tool for predicting post-operative mortality in patients undergoing emergency craniotomy. Its integration into clinical practice can enhance risk stratification and inform clinical decision-making. Further studies with larger cohorts and diverse populations are warranted to generalize these findings.
Comparison between negative pressure wound therapy and platelet-rich plasma therapy in management of diabetic foot
Authors: Ekta Jain  , Saurabh Saxena  , Ajay Pathak  , Kusum Mahour  , Neha Sharma  , Shiv Shakti Yadav  , Rachna Gupta
Published: January 2025

Background: Foot infections and ulceration are the most frequent reason for hospitalization in patients with diabetes mellitus (DM), accounting for up to 25% of all patients with DM admission. In the new advanced therapies for treating diabetic foot ulcers (DFUs), platelet-rich plasma (PRP) and negative pressure wound therapy (NPWT) have shown promising results.
Aims and Objectives: The objectives of the study are as follows: To study the role of NPWT and PRP in management diabetic foot wounds and to compare granulation tissue formation, total duration of wound healing, and hospital stay between two therapies in diabetic foot wounds.
Materials and Methods: This study was conducted with 100 patients of diabetic foot wounds meeting the inclusion criteria with pre-structured proforma and written informed consent for the therapies. After surgical debridement of the wound, the enrolled patients were randomized into two groups to receive either PRP therapy (Group A) (n=50) or NPWT (Group B) (n=50).
Results: PRP and NPWT both were effective in healing process of diabetic foot patients. The mean value of Group A in granulation tissue score were 2.10±0.73 and 1.90±0.60 in Group B showed no significant difference. The duration of hospital stay was lower in Group A as compared to Group B that is 19.04±4.85 days in Group A and 35.86±7.35 days in Group B. The total duration of wound healing in Group A was longer that is 7.22±3.34 weeks in Group A and Group B was 4.0±2.27 weeks.
Conclusion: PRP (Group A) and NPWT (Group B) are novel tools in management of DFUs. PRP is more simple, more safe, less costly, less equipment requirement, less complication, shorter time for the method, less painful, less hospital stay, and autologous nature in the preparation and had proved the superiority over NPWT.
Effectiveness of 8 weeks of Panchakshari mantra chanting on cognitive and psychological parameters in young adults
Authors: Anitha Lakshmi  , Bhargavi SK  , Shashikumar SD  , Yashica Gowda R  , Sai Sailesh kumar Goothy  , Mukkadan JK
Published: January 2025

Background: It was reported that those who practice chanting of the Shiva panchakshari mantra can overcome stress, attain prosperity, and get stability in life. However, there are no research studies in this area in the PubMed literature to support scientific evidence.
Aims and Objectives: The present study was undertaken to observe the effectiveness of 8 weeks of Panchakshari mantra chanting on cognitive and psychological parameters in young adults.
Materials and Methods: A total of 60 young adults were part of the study after obtaining the written informed consent. After recruiting, they were randomly assigned to two groups, control and experimental groups with 30 participants in each group. After recording the baseline, the participants in the experimental group were trained in chanting the panchakshari mantra for a week under the supervision of Vedic teachers. The participants in the control group were not allowed to chant during the study period. All the parameters were recorded in both groups after 8 weeks of the intervention.
Results: There was a significant decrease in the depression, anxiety, and stress scores of the participants of the experimental group after the intervention. There was a significant improvement in the scores of spatial and verbal memory in the participants of the experimental group followed by the intervention.
Conclusion: There was a significant improvement in the verbal memory scores in the participants of the experimental group. There was a significant decrease in the depression, anxiety, and stress scores of the participants followed by the chanting. The study recommends further detailed studies in this area to provide further scientific evidence.
Coronary artery atherosclerosis in reproductive age group women-an autopsy study
Authors: Chaithra R Jadhav  , Fremingston Marak  , Bharathi Pradeep
Published: January 2025

Background: Atherosclerosis is the most common coronary artery disease (CAD). It leads to the blocking of arteries and myocardial infarction (MI). Many studies are focused on men. The aim of this study is to look at the prevalence of coronary atherosclerosis, its severity, and arteries involved in postmortem hearts in reproductive age group women.
Aims and Objectives: The objectives are (1) to estimate the occurrence of coronary atherosclerosis in reproductive age group women of 15–50 years. (2) To grade the atherosclerosis and stenosis. (3) To determine the cardiac changes associated. (4) To note the most common artery involved. 
Materials and Methods: This study was autopsy-based retrospective study done for period of 3 years. From the autopsy forms, details such as age, gender, cause of death, and gross findings were noted. The sections from the left coronary artery (LCA), right coronary artery, left anterior descending (LAD), and circumflex artery (LCA) were reviewed microscopically to note the atherosclerotic grade and percentage of stenosis. Myocardium was reviewed for associated cardiac changes. Range, frequencies, percentage, and P-value were calculated. P<0.05 was taken statistically significant.
Results: Eighty-seven cases belonging to the reproductive age group of 15–50 years were categorized into 4 age groups. Type V American Heart Association atherosclerosis grade was seen more in women between 35 and 50 years. LAD was the most common artery to be involved. Eight cases showed acute MI.
Conclusions: Women of reproductive age group should be screened from 3rd decade onwards for CAD.
Attitude toward body donation among the non-medical support staffs in a tertiary care center of Eastern India
Authors: Anasuya Ghosh  , Riya Ben  , Astom Mondal
Published: January 2025

Background: Anatomy is a basic fundamental subject of medical science. Cadaveric dissection is an essential part of the anatomy teaching-learning process to provide detailed in-depth knowledge about the structural organization of organs in human the body to medical students. Human cadavers are mainly obtained by the body donation program, but the rate of body donation is not adequate in various parts of the country.
Aims and Objectives: This study was conducted to assess the attitude toward body donation among the non-medical support staffs in a tertiary health care setup in Eastern India.
Materials and Methods: After ethical approval was obtained, a face-to-face interview was conducted among 151 non-medical support staffs using a structured questionnaire. The data were analyzed using Microsoft Excel and Epicollect5 software.
Results: This study revealed that 44.37% of the participants were willing to donate their bodies for medical science after their death. The willingness was relatively higher among the male population, with urban residence, higher education level, and higher income group. The main motivation toward body donation was to help society by helping medical science. The main reason behind unwillingness was being uncomfortable about donating own body.
Conclusion: Target-oriented awareness program could be conducted to increase motivation toward body donation. Publicly acknowledging the body donors and showing respect to the cadaver and donor family might increase willingness toward body donation.
Comparative study of Bupivacaine with magnesium sulfate versus bupivacaine with dexmedetomidine in peripheral nerve stimulator-guided transversus abdominis plane block for post-operative analgesia in cesarean section
Authors: Himanshu Sharma  , Mahesh Verma  , Ashok Mittal  , Roopesh Kumar
Published: January 2025

Background: Magnesium sulfate and dexmedetomidine can be used as an adjuvant to local anesthetic solutions to enhance the quality and duration of peripheral nerve blocks.
Aims and Objective: The objective was to compare magnesium sulfate and dexmedetomidine as adjuvants to bupivacaine (0.25%) in a transversus abdominis plane (TAP) block using a peripheral nerve stimulator (PNS) for post-operative pain relief in parturients undergoing caesarean delivery.
Materials and Methods: A total of 150 pregnant women of ASA Grade I and II in the age range of 18–40, underwent elective cesarean delivery under the subarachnoid block, were divided into three groups of 50 each: Group A (bupivacaine and normal saline), Group B (bupivacaine and MgSO4), and Group C (bupivacaine and dexmedetomidine). Following caesarean delivery, all participants went through a bilateral PNS guided TAP block utilizing one of the treatment techniques. At 0 h, 2 h, 4 h, 6 h, 12 h, 24 h, and 48 h, all patients were monitored for pain, hemodynamic parameters, and side effects.
Results: The present study was carried out on 60 patients of thyroid lesions, out of which 21 cases were benign and 39 cases were malignant lesions. Correlation between ICC and reverse transcription-polymerase chain reaction (RT-PCR), a significant correlation was observed between ICC and RT-PCR for BRAF mutation (P<0.001). As per location of tumor is concerned, no significant correlation was observed with BRAF through ICC (P>0.001). The total concordance between ICC and quantitative RT-PCR was 96.8% (Pearson Chi-square test P-value is less than the significance level (0.05), which was statistical significant (P<0.001). The sensitivity and specificity of BRAF ICC on cellblock in malignant thyroid lesions was 76.9% and 100%, respectively. The sensitivity and specificity of BRAF RT-PCR on cellblock in malignant thyroid lesions was 79.4% and 100%, respectively. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of combined BRAF ICC with RT-PCR was 96.8%, 100%, 100%, 90%, and 97.5%, respectively, on cellblock in malignant thyroid lesions.
Conclusion: Dexmedetomidine and magnesium sulfate can be safely used as an adjuvant to bupivacaine (0.25%) to prolong the duration of pain relief while reducing the consumption of other analgesics without significant side effects.
To compare the efficacy of hyperbaric levobupivacaine (0.5%) versus hyperbaric bupivacaine (0.5%) in the subarachnoid block for infraumbilical surgeries
Authors: Rachna Gupta  , Jitendra Agrawal  , Preeti Goyal  , Shreya Putta  , Bharat Tarachandani
Published: January 2025

Background: Spinal anesthesia is the neuraxial regional anesthesia technique used in infraumbilical surgeries such as inguinal hernia, hydrocele, hysterectomy, and lower limb surgeries. Levobupivacaine and bupivacaine are local anesthetic agents used for spinal anesthesia.
Aims and Objectives: The aim of the study was to compare the efficacy of hyperbaric levobupivacaine (0.5%) versus hyperbaric bupivacaine (0.5%) in subarachnoid blocks for infraumbilical surgeries.
Materials and Methods: A total of 112 patients with American Society of Anesthesiologists grades 1 and 2 scheduled for infraumbilical surgeries were randomly divided into two groups. Group L received 3 mL of hyperbaric levobupivacaine, and group B received 3 mL of hyperbaric bupivacaine intrathecally. The onset of sensory block, onset, and duration of motor block, duration of analgesia and time of first rescue analgesia, hemodynamic parameters, and post-operative side effects, if any, were recorded.
Results: The time of onset of sensory block at T10 for group L was 03.16±00.29 min and for group B was 02.16±00.27 min and the time of onset of motor block was higher in group L (03.29±00.32 min) compared to group B (02.45±00.32 min). Duration of motor block was significantly shorter in group L (209.80±6.44 min) compared to group B (252.41±11.49 min). All these findings were statistically significant.
Conclusion: Levobupivacaine had a delayed onset of sensory and motor block as compared to bupivacaine, but due to its short duration of motor block and better hemodynamic profile, it seems to be a better alternative to bupivacaine.
Assessment of psychological, cognitive parameters and sleep quality in newly diagnosed patients with Parkinson’s disease
Authors: Anitha Lakshmi  , Venkatesha R  , Doreswamy Kanakaiah  , Yashica Gowda R  , Sai Sailesh Kumar Goothy  , Mukkadan JK  , Sadgunothama Goud Kamparaj
Published: January 2025

Background: Parkinson’s disease is a neurodegenerative disorder that occurs due to the damage of the neurons that secrete the neurotransmitter called dopamine and the cases are growing worldwide. The studies on the observation of the non-motor symptoms in patients with Parkinson’s disease are sparse in the Indian context. The estimated prevalence of Parkinson’s disease in India is 7 million.
Aims and Objectives: The present study was undertaken to assess the psychological and cognitive parameters and sleep quality in newly diagnosed patients with Parkinson’s disease.
Materials and Methods: A total of 30 newly diagnosed patients within the age group of 35–70 years, with Parkinson’s disease were part of the study after obtaining the informed consent. Thirty age and gender-matched healthy participants were also part of the study. Cognitive parameters were recorded using spatial and verbal memory tests. The psychological parameters were collected using the generalized anxiety disorder seven questionnaires which is a self-administered questionnaire. Sleep quality was assessed using an insomnia severity questionnaire which is a seven-item questionnaire.
Results: The anxiety scores were significantly high in the patients with Parkinson’s disease when compared with the controls. The sleep quality was significantly poor in the Parkinson’s patients compared to the controls. Spatial and verbal memory scores were significantly lower in Parkinson’s patients than in the controls.
Conclusion: The present study results support that the non-motor symptoms are also prominent in patients with Parkinson’s disease. Higher scores of anxiety, lower scores of spatial and verbal memory, and poor sleep quality were observed in patients with Parkinson’s disease. The study recommends further detailed studies in this area to consider these parameters also in managing Parkinson’s disease.
Comparison of ease of endotracheal intubation with fixed height pillow versus pillow height attained by alignment of external auditory meatus to sternal notch
Authors: Priyanka Bansal  , Pulkita Kataria  , Kirti Kshetrapal  , Hemant Kamal  , Renu Bala  , Geeta Ahlawat
Published: January 2025

Background: Endotracheal intubation is considered to be the “Gold Standard” for airway management during the administration of general anesthesia and in critical care setting because of its advantages, which allows delivery of anesthetic gases and oxygen through positive pressure ventilation without inflation of stomach, permits access to tracheobronchial tree for pulmonary hence minimizing the risk of gastric content aspiration, and improves surgical access to head and neck. The major determinants of easy tracheal intubation are optimal laryngoscopy and a good visualization of the glottis.
Aims and Objectives: The aims and objectives of the study are to seek the optimal pillow height that gives the best direct laryngoscopic view and can be recommended as the starting head position before direct laryngoscopy in adults.
Materials and Methods: The present study was conducted in a prospective randomized comparative manner in the Department of Anaesthesiology and Critical Care, Pt. B.D. Sharma University of Health Sciences, Rohtak after obtaining approval from the institutional ethical committee (approval number: No. BREC/Th/20/Anaesth.../034). Patients included were scheduled for elective surgery under general anesthesia requiring endotracheal intubation. The inclusion criteria were patients aged 18–50 years of either sex of ASA I and II.
Results: A total of 50 subjects, 25 in each group, were included in the final analysis. Following observations and results were drawn from the present prospective and randomized study using appropriate statistical tests. The various observations were out of 50 patients in the study population, and the mean age in years of patients in Group 1 was 38.48±11.77 years and 39.36±11.64 years in Group 2.
Conclusion: To conclude, alignment of external auditory meatus to sternal notch offers better conditions for endotracheal intubation than conventionally used sniffing position when assessed in terms of Cormack–Lehane grading and time taken for laryngoscopy and intubation.
Correlation of circulatory VEGF and miRNA 126 in angiographically proven coronary artery disease and its clinical importance
Authors: Manzeela Swale  , Neetu Kushwaha  , Mohd Sajid Khan
Published: January 2025

Background: Atherosclerotic ischemic coronary artery disease (CAD) is a major cause of morbidity and mortality in both developed and developing countries, indicating the need for the discovery of deeper molecular insights of CAD mechanisms, biomarkers, and innovative therapeutic targets. Vascular endothelial growth factor (VEGF) may have some role, in the progression of human coronary atherosclerosis. Circulating microRNAs (miR) have a potential as a diagnostic as well as a prognostic biomarker of cardiovascular disease and dysfunctions.
Aims and Objectives: The aim of the study was to correlate the levels of miRNA-126 and VEGF in the serum of CAD patients.
Materials and Methods: The study was conducted on 100 cases of freshly diagnosed CAD patients (angiographically proven) and 80 normal healthy patients. Various serum biomarkers were estimated. The level of serum VEGF and Mi-RNA was correlated for CAD patients.
Results: Highly significantly difference was found in levels of hemoglobin A1C, low density lipoprotein, total cholesterol, and total homocysteine while high-density lipoproteins and triglycerides were less significantly different for controls and cases. VEGF levels of CAD cases were found to be very significantly higher as compared to controls. The miRNA-126 expression was found to be lower in the CAD subjects compared to non-CAD subjects.
Conclusion: The study was suggested the role of VEGF in atherogenesis and plaque instability. No significant correlation was found among between miR-126 levels and VEGF levels among CAD cases. The study is limited by a smaller sample size and was single-centered; therefore, multicentric study with a larger patient cohort needs to be done and to validate our findings.
Immunohistochemical expression of p53, beta-catenin, and PD-L1 in colorectal carcinoma with respect to grade and stage-an observational study in a tertiary care center
Authors: Sanghamitra Mukherjee  , Sucharita Sarkar  , Rena Guha  , Palash Kumar Mandal  , Meghadipa Mandal
Published: January 2025

Background: Colorectal cancer (CRC) has consistently shown a global rise in incidence. p53 exerts regulatory function in signaling processes, with the p53 mutation accelerating the late stage of colorectal carcinogenesis. Programmed death ligand 1 (PD-L1) is an immune checkpoint regulator whose role in targeted therapy of CRCs needs to be evaluated. Beta-catenin plays a fundamental role in cell adhesion, with long-term effects on disease progression and survival. A detailed evaluation of all these factors is essential to tailoring new therapeutic approaches in advanced-stage cases.
Aims and Objectives: To study the immunohistochemical (IHC) expression of p53, PD-L1, and beta-catenin in different histologic grades and stages of colorectal carcinomas.
Materials and Methods: A total of 29 cases of segmental colectomy were included in the study population. Tumor sections were sent for IHC study of p53, PD-L1, and beta-catenin and interpreted as per standard protocol. Findings were tabulated against the histologic grade and stages of CRCs. Statistical analysis was done using SPSS 25.0 to test for statistical significance at P<0.05.
Results: The study population predominantly consisted of males (66%), mainly in the age group of 46–60 years. p53 was significantly more expressed in left colonic tumors. PD-L1 expression was also significantly associated with histologic grade and nodal metastasis. High beta-catenin expression was seen in well-differentiated adenocarcinomas and lower T and N-stage disease. Positive p53 also correlated with positive PD-L1 expression. However, expression of p53 was also high in tumors with low beta-catenin expression.
Conclusion: p53, PD-L1, and beta-catenin may have a role in prognostication and predicting long-term survival outcomes in CRC cases. These may also act as potential therapeutic targets with a more detailed evaluation and a larger sample size of CRC cases.
Perioperative management of awake craniotomy: Role of anesthesiologist
Authors: Chayanika Kutum  , Prashant Lakhe  , Uzma Begum
Published: January 2025

Awake craniotomy is performed for resection of lesions located within or close to the eloquent areas of the brain. Both asleep-awake-asleep technique and conscious sedation have been used effectively for awake craniotomies, and the choice of optimal anesthetic regime is mainly as per the preferences of the anesthesiologist and surgical team. Propofol, remifentanil, dexmedetomidine, and scalp nerve block have been used successfully for intraoperative brain mapping. Appropriate patient selection, adequate perioperative psychological support, and proper anesthetic management for patients in every stage of surgery are essential for the safety and success of the surgery.
A rare case of caseous necrosis of mitral valve
Authors: Deepti Naik  , Sanjaya Viswamitra
Published: January 2025

Caseous calcification of the mitral annulus, an uncommon kind of intracardiac mass, is a form of degenerative disease that afflicts the mitral valve causing liquefactive or caseous necrosis. Caseous calcification of mitral annulus is rarely encountered in practice; however, it should be on the list of differential diagnosis of any intracardiac masses located close to the mitral annulus.
Can concurrent use of king vision video laryngoscope and fiberoptic bronchoscope improve efficacy and safety of awake intubation in patients with limited mouth opening? - A case report
Authors: Sunana Gupta  , Rahul Gupta  , Nandita Mehta  , Heena Saini
Published: January 2025

Securing the airway by endotracheal intubation in a patient with a restrictive mouth opening poses a challenge to anesthesiologists. Awake tracheal intubation using flexible fiberoptic bronchoscopy is the gold standard in the anesthetic management of patients with restricted mouth openings. Awake video laryngoscopy (VL) is being increasingly used for the management of the anticipated difficult airways. We report a case of temporomandibular joint ankylosis with restrictive mouth opening posted for laparoscopic nephrectomy managed by awake intubation with the combined use of king vision VL (KVVL) and fiberoptic bronchoscope (FOB). KVVL provided an improved and clear view of the airway structures and FOB helped in guiding and maneuvering the tube safely into the larynx. The combined use of KVVL and FOB enhanced the effectiveness and safety of the procedure.
Obstetric outcomes of teenage pregnancies: A record-based study in a rural hospital of North 24 Parganas district, West Bengal
Authors: Paramita Sarkar  , Payel Sarkar  , Arnab Sarkar  , Saibendu Kumar Lahiri
Published: January 2025

Background: Teenage pregnancy is a pregnancy in a woman within 10–19 years of age groups. It results from a number of factors such as early age at marriage, illiteracy, poverty, premarital sex, lack of awareness, and access to contraception. Teenage pregnancy imposes serious social and medical implications relating to both maternal and child health. It is a worldwide public health problem in both developed and developing countries.
Aims and Objectives: The study was conducted in a rural hospital of North 24 Parganas in West Bengal. The primary objective was to compare different maternal and perinatal outcomes of teenage primigravida mothers with those of adult primigravida mothers. The secondary objective was to assess the association between various sociodemographic factors on the prevalence of teenage pregnancy.
Materials and Methods: The cross-sectional hospital record-based study includes a sample of 78 study subjects each in cases and comparison group. Records were taken from June 2019 to December 2019.
Results: Of a total of 379 labor room admissions during the study period, 86 (22.69%) were of the teenage group and 8 cases were excluded from the study. A total of 78 teenage pregnancies were analyzed and compared with 78 adult pregnancies. The mean (standard deviation) age of teenage in our study was 18.10±0.63 and that of the comparison group was 22.74±1.68 years. Results revealed that teenage mothers had a statistically higher proportion of anemia (OR=2.30, P=0.05) and low-birth-weight babies (OR: 3.6, P=0.05) compared to adult-primigravida mothers, respectively.
Conclusion: Teenage pregnancy is still a rampant and important public health problem in India with unfavorable perinatal outcomes and needs to be tackled on a priority basis.
Small cell variant of osteosarcoma of the patella: A rare case report with review of literature
Authors: Javed Ahmad  , Brij Mohan Patel
Published: January 2025

Patella is an uncommon site for the occurrence of bone tumor. Benign tumors are more common as compared to malignant ones. Osteosarcoma of the patella is a very rare tumor with only a few cases reported in the literature. Here, we present a rare case of a small-cell variant of osteosarcoma of the patella. A 12-year-old boy presented to us with pain and swelling over his left knee for 6 months. On X-ray, expansion with osteosclerotic and osteolytic lesions was found in the patella and a suspected diagnosis of osteosarcoma was made. The patient was managed by excisional biopsy of the patella and V–Y plasty of the quadriceps tendon. Results of histopathological and immunohistochemistry analyses were consistent with osteosarcoma of small cell variant. The patient was referred to a higher center after the operation for radiotherapy and chemotherapy. On the final follow-up, after 1 year, the patient was found to have expired. Osteosarcoma of the patella is a rare condition. Further studies with a number of cases and longer duration of follow-up are warranted to obtain better insight that can aid in devising management protocol, prediction of survival, and functional outcome of different surgical interventions for these patients.
Delicate threads: A case study on velamentous placenta and its clinical significance
Authors: Smriti Anand  , Dahiya Pushpa , Shikha Madan  , Sonia Dahiya
Published: January 2025

Velamentous placenta insertion is a rare and potentially serious pregnancy complication involving the abnormal attachment of the umbilical cord to the fetal membranes rather than to the placenta.This case report details the management of a 23-year-old primigravida at 38 weeks of gestation who presented to the labor room in spontaneous labor.Initial examination revealed a term-size uterus, vertex presentation, and moderate contractions,with a fetal heart rate of 144/min. Despite an unremarkable start to labor, persistent fetal heart decelerations post-amniotomy led to the discovery of velamentous insertion of the placental cord.This case discusses the challenges, decision-making process, and outcomes associated with this rare condition, ultimately resulting in an uneventful postoperative period and successful discharge on the 5th day for both mother and baby.
Netiquette and social media engagement of doctors: A renaissance in health-care delivery
Authors: Madhavi Gajula  , Bhanupriya S Pande  , Bhuvana Gajula  , Shwetha Hariba
Published: January 2025

Background: Netiquette is the term used for online etiquette or Internet etiquette. It refers to a set of guidelines, acceptable for communication. With the advent of the pandemic and online taking the major stage for discharging the majority of professional duties, proper netiquette practices among professionals are the basic necessity.
Aims and Objectives: The aims and objectives of the study are to assess the knowledge regarding netiquette and its practices among health-care professionals (HCPs) and to determine the factors associated with social media engagement among doctors.
Materials and Methods: A cross-sectional observational study was conducted for 2 months, consisting of a total of 64 participants. A pre-tested, semi-structured questionnaire was used to collect data on netiquette and its practices, the professional involvement of health-care personnel in delivering health care, and their encounter with online trolls and harassment.
Results: On analysis, it was found that 74.3% had knowledge about netiquette and its practices, however, very few had knowledge about cyberspace usage. Around 68.3% of the participants were unaware of the American Medical Association social media policy for HCPs, guiding the Internet usage for discharging their professional duties. Only 29.7% observed proper netiquette practices to avoid being cyber-bullied. Very few of the study participants faced online troll and harassment and they chose to reply to troll by facts rather than staying quiet. An in-depth study can be done by creating an awareness program as an intervention.
Conclusion: Netiquette and its practices are the key to online consultations and practices among HCPs. There is a need to create awareness among them by conducting workshops on the same.