bluuebunny/crossref_metadata_2025_split huggingface dataset:
Post-Suxamethonium Muscle Pains after Vitamin C Pretreatment
Authors: Gupta Lalit , Dwivedi Gaurav , Choudhary Kapil 
Published: May 2024

Background:
Succinylcholine has been extensively used for endotracheal intubation because of its ultrashort duration of action, quick onset with complete and predictable paralysis. However, the occurrence of some side effects like post injection fasciculations, postoperative myalgia, and increase in serum potassium levels limits its use in some situations like burns, myopathies, and myoglobinuria. For attenuation of these effects, many drugs have been studied but with limited success.

Aims and objectives:
To evaluate the role of vitamin C on attenuation of post-suxamethonium myalgia and increase in serum potassium levels.

Materials and methods:
Seventy-five females of American Society of Anaesthesiologists grade I and II and aged 20 to 50 years undergoing general anesthesia for various short surgical procedures were randomly allocated into three groups. Induction of anesthesia was performed with injection thiopentone 5 mg/kg body weight and suxamethonium 50 mg in all three groups. In group I, no drug was administered before induction of anesthesia. In group II, 500 mg tablet of vitamin C was administered twice orally a day before and on the day of surgery half an hour before induction of anesthesia. In group III, vitamin C 500 mg was administered intravenously in 50 ml saline half an hour before induction of anesthesia. The absence or presence of muscle pains and fasciculations were noted and if present, then their severity was also estimated. Serum potassium levels were measured in the venous samples collected just before induction and at 5-minute interval after the administration of suxamethonium. Patients were observed for myalgia on postoperative days 1, 2, and 3.

Results:
The patients receiving vitamin C had a little reduction in the incidents but marked reduction in severity of muscle pains and fasciculation. Furthermore, the administration of vitamin C markedly delayed the onset of muscle pains. There was no effect of vitamin C pretreatment on serum potassium levels.

Conclusion:
Pretreatment with vitamin C 500 mg may be useful in reduction of severity of post- suxamethonium myalgia.
An Audit of Antibiotic Prescribing Pattern Among Children in Emergency Settings of a Tertiary Medical College and Hospital
Authors: Manchanda Vikas , Suman Urvashi , Jhamb Urmila , Shaji Rincy 
Published: May 2024

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

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

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

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

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

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

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

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

Conclusion:
This group of patients had predominantly ischemic stroke; a significant proportion having hypertension and diabetes were not on regular treatment and were smokers. Cases of hypertension were noted to be higher in patients with increased exposure to mobile phone radiation. As a pilot study with limitations of a small number of patients, these findings could be only incidental. Further research is required to make any conclusions.
Drug Utilization Pattern in the Treatment of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS CoV 2) Patients at Dedicated COVID Tertiary Care Teaching Hospital
Authors: Singhal Shubha , Bansal Sumit , Negi Ankita , Kalra Bhupinder S. , Gupta Lalit , Garg Sandeep , Sural Sumit , Kapoor Seema , Chawla Shalini 
Published: May 2024

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Materials and Method:

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

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

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

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

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

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

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

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

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

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

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

Conclusion:
Medical professionals other than critical care medicine can be frontline care providers who can guide the ancillary departments at the peak of pandemic waves. Adherence to the standard operating protocols and interdepartmental coordination need to be effectively managed. This study can be used to formulate guidelines for further improvement in COVID patient care in case of future waves of this pandemic.