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During COVID-19 pandemic, one of the most common arrythmia reported with this illness is sinus bradycardia. Treatment for COVID-19 and associated cardiac dysfunction is still evolving. Temporary pacemaker insertion is difficult due to pandemic and risk of spread of infection to the additional staff involved. Orciprenaline stimulates the sino-atrial and atrioventricular nodes and accelerates atrioventricular conduction. Theophylline improves sinus node function in subjects with sinus bradycardia and enhances atrioventricular nodal conduction We report a case series of 10 patients admitted in dedicated COVID-19 ICUs and developed sinus node dysfunction. All of these patients were started on etophylline and theophylline prolonged release tablet (150mg) once a day. On subsequent follow up after 72 hours, all patients reported heart rate well within normal range. COVID-19 virus directly involves the myocardium by entering the cardiac myocytes resulting in inflammation and injury. As the sinus bradycardia due to COVID-19 is usually transient and respond well this drug, short course of this drug could be added to treat this arrythmia in future.
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@#Introduction: Radiation exposure during the CT examination has always been a concern due to its associated cancer risk. The guidelines suggest the optimization of radiation dose reduction. Therefore, this study aims to determine the feasibility of dose reduction strategies on radiation dose reduction using a phantom. Methods: Head and body phantoms of 16 cm and 32 cm, respectively, were used to calculate the radiation dose and measure the quantitative image quality. The phantoms were positioned and scanned with the standard protocol and low dose protocol. For dose reduction strategies, scan length was reduced in head phantom, and tube voltage and tube current were manipulated individually and by combining both and tested in both head and body phantoms. Also, the influence of rotation time was investigated in body phantom. Quantitative image quality was determined by drawing a region of interest on the obtained image. Results: Reducing scan length showed 41% reduction of radiation dose and reducing tube current, and tube voltage showed up to 75% reduction of radiation dose in head phantom and 70% reduction of radiation dose in body phantom compared to the standard protocol. The reduction of the rotation time, however, reduced the scan time and the radiation dose but the maximum mAs or tube current allowed was limited. Quantitative image quality was reduced when using a lower dose protocol. Conclusion: The dose reduction strategies showed a reduced dose, but the quantitative image quality score was reduced when scanned with low dose protocol. Further manipulation can be performed to maintain image quality.
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Heterotopic ossification (HO) is the formation of ectopic bone at non-physiological location, such as soft tissues around a joint.HO is a common complication seen after trauma and certain surgeries (e.g., total hip arthroplasty) involving specific regionssuch as hip. In neurogenic HO, ectopic bone develops in patients sustaining a spinal cord injury or traumatic brain injury(incidence 20–30%). Neurogenic HO characteristically involves major joints with hip joint being the most common, followed byelbow, shoulder, and knee joint. No reported case of HO in wrists, ankles, legs, and feet has been documented, making thesehighly rare locations. The ectopic bone may be asymptomatic or can cause significant functional impairment of the involvedjoint presenting as erythema, warmth, swelling with loss of range of motion; however, this case is a rare presentation involvingankle joint with no signs of inflammation. Plain X-rays and CT scans diagnose the new bone. Management involves primaryprophylaxis with NSAIDs, bisphosphonates (not commonly used), and radiation therapy. Surgical excision is the definitivetreatment. Neurogenic HO cases should undergo comprehensive and extended follow-up with attention to even rarely involvedsites such as ankle, wrists, hands, and feet.
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Background: Diabetic retinopathy is a slow progressing complication of diabetes mellitus with multifactorial aetiology affecting approximately 80% of diabetics worldwide. Chronic hyperglycemic milieu ofDiabetes induces biochemical changes which contribute to the pathogenesis of Diabetic retinopathy.Objective: The present study examined the protective effect of Vasant Kusumakar Ras, an Ayurvedicherbo-mineral formulation, in diabetic retinopathy.Materials and Methods: Diabetes was induced in rats by intraperitoneal injection of streptozotocin (45mg/kg). Rats were kept without any treatment for period of three weeks for induction of Diabeticretinopathy followed by treatment with Vasant Kusumakar Ras (11.25 mg/kg, p.o) for further 5 weeks.Fasting blood glucose levels, lipid profile and HbA1c were determined. Eye tissue homogenates weresubjected to biochemical analysis to determine the levels of oxidative stress parameters (superoxidedismutase, catalase, reduced glutathione, lipid peroxidation), vascular endothelial growth factor andaldose reductase activity. Histopathological analysis of retinal tissue was conducted using Hematoxylinand Eosin staining.Results: Vasant Kusumakar Ras treatment restored serum lipid profile which was altered in diabetic rats.Treatment with Vasant Kusumakar Ras significantly ameliorated the oxidative stress in eye tissueresulting in decreased lipid peroxidation and increase in endogenous antioxidant levels. Levels of aldosereductase and vascular endothelial growth factor in eye tissue were significantly decreased in VasantKusumakar Ras treated rats. Hematoxylin and Eosin staining indicated that the Vasant Kusumakar Rastreatment significantly restored the normal architecture of the retinal tissue.Conclusion: Vasant Kusumakar Ras exhibits protective effect and prevents the development of Diabeticretinopathy through its effects on multiple biochemical pathways implicated in pathogenesis of Diabeticretinopathy.
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Normal concentration of WBCs in blood varies between 4000 and 11,000 per microliter and are classified intotwo variants namely granulocytes and agranulocytes on the basis of presence and absence of granules.Manual methods of calculation of TLC include- Neubauer chamber and estimating WBC on leishman stainedslides whereas automated methods are based on impedance or light scattering technology. The study comparedthe efficacy of both these methods in statistical terms using Chi Square test. 100 cases of leucocytosisanalyzed over a period of 1 year at MMIMSR, Mullana, Haryana revealed leucocytosis prevalent in 4-6 decadeof life with slight male predominance. The pearson coefficient for TLC came out to be p value =0.215 (notsignificant) but for DLC, calculations revealed p values for polymorphs, lymphocytes, eosinophils andmonocytes to be significant (p value =0.000 each). To conclude, standard manual methods should be advocatedas special practice where there is definite need of morphological and quantitative evaluation of WBCs and tovalidate the automated methods by which the laboratories can optimize patient care and not as a replacement
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Knee is a major weight bearing and largest joint that provides mobility and stability during physical activities as well as balance while standing. Due to its wide range of functions it is exposed to forces beyond its physiological range, and thus bone and soft tissue of knee are at risk of injuries. We wanted to study MRI appearances of cruciate ligaments and meniscal tears in cases of knee injuries and correlate the MRI findings of knee injury with clinical observations/other radiological investigations/ arthroscopic findings. We also wanted to evaluate the sensitivity, specificity, PPV, NPV and accuracy of MRI in detecting knee injuries taking arthroscopy as gold standard (wherever performed).METHODSThis prospective diagnostic descriptive study was conducted in the Department of Radiodiagnosis of Maharishi Markandeshwar Institute of Medical Sciences and Research, MMDU, Mullana, among 100 patients presenting with knee injuries referred to Department of Radiodiagnosis for MR imaging. MR scans were carried out on 1.5 tesla MR machine Achieva (by Phillips Medical System) and studies were performed with the sense extremity coil. Arthroscopic knee surgery was performed in 39 patients. MR findings were correlated with clinical and arthroscopic findings wherever possible.RESULTSMR diagnosis of 100 cases was as follows: in ACL tear 50%; PCL tear 19%; MCL tear 17%; LCL tear 16%; MM tear 49%; LM tear 31%; Sensitivity, specificity, NPV, PPV and accuracy of MRI in detecting the knee injuries taking arthroscopy as gold standard are as follows ACL- 100%, 90.9%, 100%, 96.5% and 97.4 %; lateral meniscus-100%, 94.5%, 100%, 50% and 94.8%; medial meniscus 90.4%, 66.7%, 85.7%, 76% and 79.5% respectively. Correlation between MRI and arthroscopic findings regarding presence and absence of posterior cruciate ligament tear was highest with sensitivity -100%, specificity- 94.5%, NPV- 100% and accuracy-94.8%, There were 6 false positives for meniscus tear on MR examinations accounting for low positive predictive value (72%) of MR examination. Posterior horn tears of menisci are likely to be missed on arthroscopy. Out of 6 false positive cases of meniscus tear, 4 were located predominately in the posterior horn and 2 in the anterior horn. Thus, acceptance of MRI findings as false positive is controversial.CONCLUSIONSMRI is a useful non-invasive modality having high diagnostic accuracy, sensitivity and negative predictive value making it a very reliable screening test for diagnosis of internal derangements of knee joint. Thus, MRI saves many knees from unnecessary arthroscopies.
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Background: Abnormal uterine bleeding (AUB) is defined as any variation from the normal menstrual cycle such as changes in regularity, frequency, duration of flow or amount of flow. Objective of this study was to compare the adequacy and diagnostic accuracy of endometrial aspiration using Karman’s cannula versus dilatation and curettage in women with abnormal uterine bleeding.Methods: This prospective study was conducted on 250 women with AUB in age group of more than 40 years. In all patients, endometrial aspiration was done with manual vacuum aspiration (MVA) syringe attached to 4 mm Karman's cannula without anesthesia. The sample was collected in a bottle containing formalin and was labelled as sample A. After that, intracervical local anesthesia (1% Xylocaine) was given and cervix was dilated and scrapping of endometrial lining with sharp curette was done. The sample was also collected in a bottle containing formalin and was labelled as sample B. Both the samples A and B were sent for histopathology. The histopathology report of aspiration was compared with that of dilatation and curettage sample.Results: Endometrial aspiration biopsy had sensitivity of 92.3%, specificity of 100%, positive predictive value of 100% and negative predictive value of 99.56% for diagnosis of endometrial pathology while considering D and C gold standard. The sample adequacy of endometrial aspiration was 98.8% as compared to dilatation and curettage (98%).Conclusions: Present study showed that endometrial aspiration biopsy is an alternate to traditional dilatation and curettage in diagnosing endometrial pathologies in women with abnormal uterine bleeding.
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Background: The present study evaluated the changes in baseline left ventricular function and clinical symptoms in multi-vessel coronary artery disease patients after multi-vessel percutaneous coronary intervention.Methods: This was a prospective, observational study conducted at Medical Super-speciality Hospital, Kolkata, India, between August 2017 and August 2019. The study included 48 patients who were diagnosed with ≥2 coronary artery stenosis of ≥50% in native coronary arteries with left ventricular ejection fraction (LVEF) <40%. Echocardiography was performed before and after 3 months of the procedure to observe LVEF. Canadian Cardiovascular Society (CCS) score was calculated before and after 3 months after PCI.Results: Mean age of the patients was 61.89±9.96 years and 89.6% patients were male. Mean LVEF before and after angioplasty was 34.9±4.95% and 42.06±8.78%, respectively (p=0.001). CCS score before and after angioplasty was 2.89 and 1.83, respectively (p=0.001).Conclusions: The results displayed significant improvement in clinical symptoms as well as LVEF after PCI in patients with multi-vessel disease with LVEF <40%. These results will be helpful to conduct larger randomized trials with long term follow-up in order to prove the safety and effectiveness of PCI in such patients over coronary artery bypass grafting.
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Anemia, reduced red cell mass below normal range, results in reduction of oxygen carrying capacity of bloodthat results in tissue hypoxia. MCV, MCH, MCH and RDW represent a sensitive indicator to study erythrocytemorphology. Mentzer Index recommended MI<13 to be suggestive of â-TT and MI>13 for Iron deficiencyanemia. 100 cases were analyzed prospectively over a span of 1 year at MMIMSR, Mullana. The studyrevealed 34% of patients to be in age group of 21-30 years with (59%) female predominance out of whichmajority of cases were of moderate anemia (73%). Erythrocyte indices revealed pattern with majority ofsamples having MCV, MCH and MCHC to be in normal range while RDW showed increased values. Mentzerindex came out to be >14 in 96% of samples. To conclude evaluation of erythrocyte indices and Mentzerindex aids in quatitative assessment of anemia and also to distinguish between iron deficiency anemia andthalassemia trait.
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Enhanced recovery after surgery (ERAS) protocols termed as “fast track surgery” have now become an essential componentin the perioperative period to improve post-operative outcomes. It is both the patient and the health services who receive thebenefits of ERAS. It is a new and different approach when compared to traditional practices which aims at enhanced care ofsurgical patients. It includes pre-operative, intraoperative, and post-operative components which when applied altogether givebest possible results. Effective implementation of ERAS protocols is associated with fast recovery of gut function and reducedrate of complications. All these factors further lead to decreased post-operative hospital stay, thereby decreasing hospital costand increasing patient satisfaction.
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Rh system in today’s world is probably the most complex red cell antigen system in humans. The presence ofD antigen confers Rh positivity and vice versa. Two allelic antigen pairs, E/e and C/c are also found on the Rhprotein. The D antigen is the most immunogenic red cell antigen after A and B. As there is paucity of datadistribution of Rh antigen subgroup from the Indian literature, the study was conducted to know the prevalenceof Rh antigen subgroups in this part of the region and to determine the phenotype and most common genotypeof Rh antigen among the blood donors. The observational 1 year prospective study was conducted on blooddonors attending the blood bank in the Department of Pathology, MMIMSR, MMDU, Mullana.The studycomprised of blood donors of various age groups which included 90%(450) males and 10%(50) females. Anoverall Rh D positivity was seen in 88.4% of blood donors while 11.6% lacked the D antigen. The mostcommon Rh phenotype was ccDEE 26.6%. In conclusion, sensitization to clinically important blood groupantigens can be prevented through complete blood typing. All patients should be genotyped before the firstblood transfusion
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The study included gastric endoscopic biopsies received in the department of pathology, MMIMSR,Mullana, Haryana. 130 gastric biopsies were included in the study. The most common presentingcomplaint was pain abdomen. The neoplastic lesions commonly presented as carcinoma whereas thenon-neoplastic lesions presented as inflammatory lesions on endoscopy. Non-neoplastic lesions werefound to be common out of which gastritis was the most common lesion. Associated conditions werefound to be H. Pylori and intestinal metaplasia with gastritis. Majority of the lesions were nonneoplastic, presenting with pain abdomen & inflammatory findings on endoscopy. The neoplasticlesions comprised of adenocarcinoma & signet ring cell carcinoma. 4 cases of signet ring cell carcinomawere noted. Percentage of concordance between endoscopic & histologic diagnoses was calculatedwherein cases of gastritis, ulcer, polyps & carcinoma showed 100%, 96.3%, 71.4% & 100%concordance respectively.The conclusion of the study was that histological examination in adjunct with endoscopy should beconsidered as much more valuable diagnostic tool rather than endoscopy alone.
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The study included endoscopic duodenal biopsies received in the department of pathology, MMIMSR,Mullana, Haryana. 44 biopsies were included in the study. The most common presenting complaintwas pain abdomen followed by diarrhea. The neoplastic lesions commonly presented as carcinomawhereas the non-neoplastic lesions presented as inflammatory lesions on endoscopy. Non-neoplasticlesions were found to be common with villous atrophy predominating the list. Majority of the lesionswere non-neoplastic, presenting with pain abdomen & inflammatory findings on endoscopy. Theneoplastic lesions comprised of adenocarcinoma. A single case of ampullary carcinoma was alsonoted. Percentage of concordance between endoscopic & histologic diagnoses was calculated whereinduodenitis, scalloping, polypoidal & carcinomatous lesions showed 100%, 60.7%, 0% & 100%concordance between the two diagnostic modalities respectively. The conclusion of the study wasthat endoscopic examination alone might miss out in diagnosing majority of the lesions. So, histologicalexamination in adjunct with endoscopy should be considered as much more valuable diagnostic toolrather than endoscopy alone.
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Presence of haematoma, serous fluid, and dead space in a wound increase the risk of infection as they act as a culture media. Multiple options had been mentioned to reduce these risks. We tried to assess the incidence of SSI following placement of closed suction drains following elective surgeries. Methods: A prospective observational study was conducted in the Department of General Surgery, IPGMER & SSKM Hospital, Kolkata from January 2016 to June 2017. Patients who were given a subcutaneous suction drain after an elective general surgical procedure were included in the study. Patients unwilling to take part in the study, patients from paediatric age group, on steroids, with Class 4 wounds and those underwent Laparoscopic Surgery were excluded. Outcome was measured in the form of presence or absence of SSI and data was analysed. Results: No statistically significant decrease of incidence of SSI was found in terms of different age, sex, socio-economic status, duration of hospital stays, smoking or alcoholism. Increased incidence of SSI was detected among Diabetics even after using closed suction drainage. Conclusion: Placement of closed suction drain did not significantly reduce incidence of SSI following elective general surgical procedures.
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Ligation of Intersphincteric Fistulous Tract (LIFT) is a novel and promising technique in the management of Fistula in ano. We tried to assess the outcome of LIFT procedure in our institute in terms of healing rate, incontinence and recurrences. Methods: A prospective observational study was performed in the Department of General Surgery, IPGMER and SSKM Hospital, Kolkata, India between January 2016 and August 2017. Thirty patients were selected with simple randomization after applying all inclusion and exclusion criteria and all underwent LIFT procedure. Results: Among the 30 patients included in our study, the healing rate varied from 76.7% in 2-week follow-up to 93.3% on 6 months follow-up. One patient had Grade B incontinence from which he recovered within 1 month. One diabetic patient had recurrence of the disease. Conclusion: LIFT is a promising procedure for both simple or complex fistulas with single or multiple tracts with minimum incidence of incontinence or recurrence. However, larger randomised controlled trials with large study population is required.
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Identification and protection of Facial Nerve is of prime importance during surgery of parotid glands. Several techniques are available in literature to identify and preserve FN. We present here a case series with dissection of FN in a novel technique during parotidectomy which has significantly lowered the morbidity due to injury of the FN. Methods: All data, from all the patients who underwent Parotidectomy in our unit (conducted or supervised by a single surgeon) in the Department of General Surgery, IPGMER and SSKM Hospital, Kolkata, between March 2014 to March 2019, using our novel technique for identification and protection of FN, was retrospectively analysed. Outcome measurement was expressed in terms of type of surgery, duration, estimated blood loss, any intra-operative or post-operative complications, length of hospital stay, duration of drain in place, Histopathological (HPE) reports, size of the tumour, margin and lymph node status, Facial Nerve weakness and other complications. Results: Total 13 patients underwent Parotidectomy (Total or Superficial) following our technique of identifying and protecting Facial Nerve (FN). Four of them had temporary FN paresis in immediate post-op period. None of the patients had FN paresis on follow-up at 1 year. Conclusion: The novel technique described in our study for identification and protection of FN is a promising technique for Parotid Surgery.
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Cervical cancer is most familiar neoplasm among women worldwide. Surgery, radiotherapy, and chemotherapy are common treatments, however high stage tumors have frequently poor prognosis. HPV 16 and 18 are major etiological factors for cervical cancer. Likewise, epigenetics is the study of inherited changes and modulated gene expression without alteration in DNA sequences. In mammals epigenetic modifications include DNA methylation, histone modifications and miRNA. Phytochemicals are mainly contained in fruits, seeds, and vegetables as well as in foods supplements. Numerous dietary compounds exhibit potent anti-tumor activities through the reversion of epigenetic alterations associated to oncogenes activation and inactivation of tumor suppressor genes in cervical cancer cell lines SiHa and HeLa, demethylation of the tumour suppressor genes such as RARβ2, MGMT, RASSF1A, DAPK etc. Reversal of hypermethylated genes as a tumor-suppressor gene, is related to inhibition of cell proliferation, development and differentiation. The impact of phytochemicals lead to the reversal of hypermethylation which may help to cure cervical cancer. This study concludes the effect of phytochemicals on genetic and epigenetic modifications and reveals how these modifications help to prevent various types of cancers and improve health outcomes.
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Severe pulmonary embolism as first-time presentation of Nephrotic syndrome is rare but Nephrotic syndrome secondary to membranous nephropathy (MN) may impose a greater thrombotic risk for unclear reasons. Here, we report the case of a 36-year-old female patient presented with complaints of sudden onset of shortness of breath since 4-5 days and features of right-sided heart failure. There was no preceding history of any chronic disease or renal disease. She was diagnosed as having a bilateral severe pulmonary embolism. Extensive workup and renal biopsy were done which was suggestive of primary membranous nephropathy.
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Introduction: Most foreign bodies in the G.I tract areasymptomatic and probably pass spontaneously in stool. Fewmay cause complications and require interventions. Diagnosiscan be a challenge in certain cases. We present a case in whichthe ingestion of a Neem Twig caused duodenal perforationmimicking Acalculous Cholecystitis.Case report: A 63-year-old lady visited emergency withacute abdominal pain of 2 day history. Computed tomography(CT) showed mildly thickened Gall bladder with loculatedpericholecystic fluid collection which is extending intosubcapsular region of segment III of liver. A LaparoscopicCholecystectomy was planned in view of Acalculouscholecystitis. Intraoperative, an Omental phlegmon guardinga Neem (Azadirachta indica) twig which perforated out ofduodenum was found. Laparoscopy was converted to an openmidline Laparotomy and graham’s Omental patch repair ofduodenum perforation was done.Conclusion: The patient has been doing well since theoperation. She gave history of swallowing the Neem Twig6 Months prior to this surgery. Many a times open surgicalapproach would give a satisfactory search rather thanLaparoscopy
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Snakebite is a common presentation in India, especially in the Sub-Himalayan region. The most common presentation of snakebite is neurotoxic and hematologic complications. Acute coronary syndrome after a snakebite is rare. This case report explicitly explains a patient presenting as acute coronary syndrome after a snakebite with dynamic electrocardiogram changes. Later on, the anti-snake venom therapy was given to the patient and her condition improved. It should be kept in mind that, since the pathology of snakebite-induced myocardial infarction is different, its management will also be different.