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Background@#Dynamic parameters used for predicting fluid responsiveness require special equipment and are minimally invasive. Therefore, recent interest in the use of carotid artery ultrasound parameters, such as carotid corrected flow time (FTc) and peak velocity variation (ΔVpeak) has grown. Therefore, we performed this systematic review and meta-analysis to assess the ability of carotid FTc and/or ΔVpeak to accurately predict fluid responsiveness. @*Methods@#We searched the PubMed and Embase databases for articles evaluating the diagnostic accuracy of carotid FTc or ΔVpeak for predicting fluid responsiveness. Two independent authors performed the search and selected studies published until May 2022. The studies were assessed for the inclusion and exclusion criteria using Rayyan (Rayyan Systems Inc., 2022). @*Results@#Ten studies (n=438) that fulfilled the inclusion criteria were selected. Studies were divided into those assessing carotid FTc and those assessing carotid ΔVpeak. Five studies (six datasets) assessed FTc. The pooled sensitivity and specificity of carotid FTc were 0.76 and 0.88, respectively. The summary receiver operating characteristic (SROC) curve for carotid FTc had an area under the curve (AUC) of 0.9092, with a Q value of 0.8412. Seven studies calculated carotid ΔVpeak. The pooled sensitivity and specificity for ΔVpeak were 0.83 and 0.81, respectively. The SROC curve had an AUC of 0.8941 and a Q value of 0.8250. @*Conclusions@#Our meta-analysis showed that both carotid FTc and ΔVpeak are useful for predicting fluid responsiveness in anesthesia and critical care settings with good specificity and sensitivity.
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Justification: Anemia in children is a significant public health problem in our country. Comprehensive National Nutrition Survey 2016-18 provides evidence that more than 50% of childhood anemia is due to an underlying nutritional deficiency. The National Family Health Survey-5 has reported an increase in the prevalence of anemia in the under-five age group from 59% to 67.1% over the last 5 years. Clearly, the existing public health programs to decrease the prevalence of anemia have not shown the desired results. Hence, there is a need to develop nationally acceptable guidelines for the diagnosis, treatment and prevention of nutritional anemia. Objective: To review the available literature and collate evidence-based observations to formulate guidelines for diagnosis, treatment and prevention of nutritional anemia in children. Process: These guidelines have been developed by the experts from the Pediatric Hematology-Oncology Chapter and the Pediatric and Adolescent Nutrition (PAN) Society of the Indian Academy of Pediatrics (IAP). Key areas were identified as: epidemiology, nomenclature and definitions, etiology and diagnosis of iron deficiency anemia (IDA), treatment of IDA, etiology and diagnosis of vitamin B12 and/or folic acid deficiency, treatment of vitamin B12 and/or folic acid deficiency anemia and prevention of nutritional anemia. Each of these key areas were reviewed by at least 2 to 3 experts. Four virtual meetings were held in November, 2021 and all the key issues were deliberated upon. Based on review and inputs received during meetings, draft recommendations were prepared. After this, a writing group was constituted which prepared the draft guidelines. The draft was circulated and approved by all the expert group members. Recommendations: We recommend use of World Health Organization (WHO) cut-off hemoglobin levels to define anemia in children and adolescents. Most cases suspected to have IDA can be started on treatment based on a compatible history, physical examination and hemogram report. Serum ferritin assay is recommended for the confirmation of the diagnosis of IDA. Most cases of IDA can be managed with oral iron therapy using 2-3 mg/kg elemental iron daily. The presence of macro-ovalocytes and hypersegmented neutrophils, along with an elevated mean corpuscular volume (MCV), should raise the suspicion of underlying vitamin B12 (cobalamin) or folic acid deficiency. Estimation of serum vitamin B12 and folate level are advisable in children with macrocytic anemia prior to starting treatment. When serum vitamin B12 and folate levels are unavailable, patients should be treated using both drugs. Vitamin B12 should preferably be started 10-14 days ahead of oral folic acid to avoid precipitating neurological symptoms. Children with macrocytic anemia in whom a quick response to treatment is required, such as those with pancytopenia, severe anemia, developmental delay and infantile tremor syndrome, should be managed using parenteral vitamin B12. Children with vitamin B12 deficiency having mild or moderate anemia may be managed using oral vitamin B12 preparations. After completing therapy for nutritional anemia, all infants and children should be advised to continue prophylactic iron-folic acid (IFA) supplementation as prescribed under Anemia Mukt Bharat guidelines. For prevention of anemia, in addition to age-appropriate IFA prophylaxis, routine screening of infants for anemia at 9 months during immunization visit is recommended.
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Introduction: TIVA has many advantages over inhalational anaesthesia such as minimal cardiac depression, decreased oxygen consumption, avoids postoperative diffusion hypoxemia, decreases the incidence of postoperative nausea and vomiting etc. This study was conducted to evaluate and compare two TIVA drug combinations using propofol- ketamine and propofol-fentanyl, and to examine the characteristics of induction of anaesthesia, maintenance, and recovery. Method: 34 patients of ASA grading 1,2 and 3 aged between 20 to 65 years of either sex undergoing short surgical procedures were included in the study. According to Comparison of systolic blood pressure of both the groups at intubation time of anaesthesia in group I and group II. Patients in group I received propofol and ketamine intravenously (IV) to induce anaesthesia. For group II, fentanyl and propofol were administered as IV bolus doses. All the results were tabulated and analyzed statistically. Result: Propofol-fentanyl combination produced a significantly greater fall in pulse rate and in both systolic and diastolic blood pressures as compared to propofol-ketamine during induction of anaesthesia. Propofol-ketamine combination produced stable hemodynamic during maintenance phase while on the other hand propofol-fentanyl was associated with a slight increase in both PR and BP. During recovery, ventilation score was better in group I while movement and wakefulness score was better in group II. Conclusions: Both propofol-ketamine and propofol-fentanyl combinations produce rapid, pleasant and safe anaesthesia with only a few untoward side effects and only minor hemodynamic effects.
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Aim: To assess knowledge, attitudes, and beliefs among dental students and faculty members regarding COVID?19 vaccines in dental colleges in Haryana, India. Objectives: To assess knowledge level, attitudes, and beliefs differences among BDS, MDS students and faculty members and find association between knowledge and COVID?19 vaccine inoculation among study participants. Materials and Methods: A cross?sectional study was carried out among students and faculty members of dental colleges in Haryana, India. Data collection was done via an online questionnaire based on questions to assess the knowledge, attitude and beliefs regarding COVID?19 vaccines. Results: The present study comprised of 270 study participants, where majority, i.e., 81.5% have reported COVID?19 vaccine inoculation. The mean knowledge score of the participants was reported to be 5.54 ± 2.19. A significant difference was found in the mean knowledge score of faculty members (7.81 ± 1.69), MDS (6.72 ± 1.49), and BDS (4.39 ± 1.68) students. COVID?19 vaccine inoculation was found to be significantly associated with average knowledge score of participants (OR = 6.1, P < 0.01). Conclusion: Dental professionals have an adequate degree of knowledge and attitude level regarding COVID?19 vaccines and are generally optimistic about resolving the pandemic situation with the immunization.
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Aim: To evaluate knowledge, attitude and practices among sanitation workers regarding SARS?CoV?2 prevention during hospital waste management. Materials and Methods: A cross?sectional study was conducted among 426 sanitation workers using an interviewer?administered questionnaire to assess the knowledge, attitude and practices of the study participants. The unpaired t?test and Spearman’s correlation were used to find the mean difference and correlation among different study variables. Statistical significance was set at 5% (confidence interval 95%). Results: The mean knowledge score of the participants was found to be 7.15 ± 2.02. About 93.7% of the participants had good knowledge about COVID?19. About 64.3% of the participants strongly agreed that COVID?19 is a life?threatening disease. Regarding practices, a majority reported (69.7%) that they washed hands frequently using water and soap. A significant positive correlation was found between knowledge, attitude, practices and education, indicating a favourable work environment in hospital settings. Conclusion: More than half of the sanitation workers and housekeeping staff had adequate knowledge of COVID?19, and their attitudes were found to be favourable. They also had satisfactory practices, which may be a result of the prompt training and sensitization of sanitation workers by the authorities. Clinical Relevance: Sanitation workers come under the essential services category and their knowledge, attitude and practices needed to be assessed and updated in the concerned area for their protection and better management of biomedical waste, especially in the current pandemic situation.
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Background:Lack of adequate sleep affects the mental health, emotional balance, immune function and reaction times. The alarming sedentary habit which would affect the sleep quality in the recent time is screen media exposure or increased screen time. Moderate use of ST (4hours/day) associated with lower psychological well-being. Objective: Tostudy the association between ST usage and sleep quality amongst young adults. Material And Methods:The study was conducted among medical students at Physiology department, Government medical college, Vadodara. Google form was created, which consisted of basic information. Self-reported ST usage per day. PSQI scale assessed 7components of sleep scaling from 0 to 3, and higher global score (>5) means lower sleep quality. The Google form was sent to participants who were given informed consent and the results were computed. Result:Among 204 participants, 78 males and 126 females, the median age was 19 years, the mean duration of screen time was 5.3 Hrs.(SD=2.7). ST > 5Hrs. in 57.8% and PSQI ?5 in 52.9% was seen. Chi Square test analysis for ST& PSQI, the p-value came out to be 0.094(p-value > 0.005), and was not statistically significant. Conclusion:This study shows more than half of participants had poor sleep quality and increased screen time usage. Though the results came out statistically insignificant we cannot exclude the association without further research. However,exposure to high screen time may negatively impact sleep outcome.
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揋uitar pick sign,� also referred to as posterior globe tenting, is a radiological surrogate marker of tense orbit and profound vision loss. It is seen commonly in traumatic retrobulbar hemorrhage and carotico-cavernous fistula and less frequently in orbital cellulitis, subperiosteal abscess, and invasive fungal infections. We report a case series of Coronavirus disease-19朼ssociated rhino-orbito-cerebral mucormycosis with guitar pick sign, of which none survived, and discuss the causative pathomechanisms, severity grade, and the clinical relevance of this unique radiological finding.
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The cancer burden continues to grow globally, exerting tremendous physical, emotional, and financial strain on individuals, families, communities, and health systems. The number of health-related mobile applications (apps) is increasing rapidly. We searched for pain apps specific for cancer patients on App Store for iOS devices and Google Play for Android devices. An integrated pain management app (IPMA) is the need of the hour, which will not only provide a platform to users to assess their pain scores but also assess other associated symptoms and can provide a step-wise assessment to their symptomatology. This can offset the patient burden in the outpatient pain clinic and reduce the number of follow-up visits by addressing common concerns that can be tackled easily at home
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Background & objectives: Serology testing is essential for immunological surveillance in the population. This serosurvey was conducted to ascertain the cumulative population immunity against SARS-CoV-2 among adults in Jammu district and to understand the association of seropositivity with sociodemographic and clinical correlates. Methods: On September 30 and October 1, 2020, a household survey was done in 20 villages/wards chosen from 10 health blocks in district Jammu, India. Demographic, clinical and exposure information was collected from 2000 adults. Serum samples were screened for IgG antibodies using COVID Kavach MERILISA kit. Tests of association were used to identify risk factors associated with IgG positivity. Crude odds ratio with 95 per cent confidence intervals (CIs) was calculated during univariate analysis followed by logistic regression. Results: Overall adjusted seroprevalence for SARS-CoV-2 was 8.8 per cent (95% CI: 8.78-8.82); it varied from 4.1 per cent in Chauki choura to 16.7 per cent Pallanwalla across 10 blocks in the district. Seropositivity was observed to be comparatively higher in 41-50 and 61-70 yr age groups, among males and in rural areas. Fever, sore throat, cough, dyspnoea, myalgias, anosmia, ageusia, fatigue, seizures, history of exposure, medical consultation, hospitalization and missing work showed significant association with seropositivity on univariate analysis. On logistic regression, only sore throat, myalgia and missing work showed significant adjusted odds of IgG positivity. Extrapolation to adult population suggested that exposure to SARS-CoV-2 was 14.4 times higher than reported cases, translating into Infection fatality rate of 0.08 per cent. Interpretation & conclusions: Since a major part of population was immunologically naive, all efforts to contain COVID-19 need to be vigorously followed while these baseline results provide an important yardstick to monitor the trends of COVID-19 and guide locally appropriate control strategies in the region
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Background & objectives: Accurate mosquito species identification is the basis of entomological surveys and effective vector control. Mosquito identification is either done morphologically using diagnostic features mentioned in taxonomic keys or by molecular methods using cytochrome oxidase subunit 1 (coxI) and Internal transcribed spacer 2 (ITS2). Methods: We performed a larval survey for Aedes mosquitoes from eight different geographical regions in Tamil Nadu, India. The mosquitoes collected during the survey were characterized using both morphological and molecular markers. Results: During an entomological survey from eight different geographical regions in Southern India, a morphological variety named Aedes aegypti var. luciensis was observed. The variant mosquitoes were characterized using both morphological and molecular markers. The variant mosquitoes differed only in the dark scaling of 5th segment of hind-tarsi. Around one third to two third of the 5th segment in variant mosquitoes was dark which has been described as white in identification keys. No other significant difference was observed in adults or immature stages. The variation was heritable and coexisting in the field with the type form mosquitoes. Comparison of the genetic profile of coxI and ITS2 were similar in variant and the type form indicating both of them to be conspecific. Interpretation & conclusion: The morphological variant mosquitoes were found genetically similar to the Ae. aegypti type form. However, considering its high prevalence and coexistence with Ae. aegypti type form in different geographical regions, detailed studies on bionomics, ecology, genetics, behavior as well as its plausible role in disease transmission are warranted.
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It is well-documented that during a war, a natural disaster or a pandemic, women bear the worse brunt of the crisis. Worldwide, mental stress, domestic violence and cybercrime against women are widespread and under-reported during Covid-19. Creating boundaries in such situations is extremely important. It is imperative that policy-makers adopt a gender perspective to understand and analyse the effects of the pandemic and the lockdown on the economy, livelihoods and social structures. United Nations has called for urgent action and for governments to put women’s safety first as they respond to the pandemic.
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Background: Dental procedures, especially local anesthetic administration, are a source of great anxiety to children. Diaphragmatic breathing is defined as an efficient integrative body–mind training for dealing with stress and psychosomatic conditions. Pinwheel exercise is also a highly effective technique of “play therapy.” Aim: This study aimed to compare dental anxiety using pinwheel breathing exercise and diaphragmatic breathing exercise during buccal infiltration anesthesia. Methodology: Sixty children in the age group of 6–12 years with Frankel's behavior rating score of 3 who required buccal infiltration local anesthesia were selected. Subjects were divided randomly into two groups, i.e., Group A: children who performed pinwheel breathing exercise and Group B: children who performed diaphragmatic breathing exercise. The level of anxiety of the patients was recorded using an animated emoji scale. The data were analyzed using IBM SPSS version 20 software with paired t-test and Chi-square test. Results: There was a significant reduction in dental anxiety score from score 1 (before the anesthetic procedure) to score 2 (after the anesthetic procedure) in both the groups. On intergroup analysis, children who performed pinwheel breathing exercise (Group A) showed higher values than children who performed deep breathing exercise without pinwheel (Group B) with a t value of 1.42 but was not statistically significant with a P value of 0.161. Conclusion: Pinwheel breathing exercise as well as diaphragmatic breathing exercise proved to be significantly effective in reducing dental anxiety during local anesthesia.
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Context: The impact of periodontal disease during pregnancy and its effect on adverse pregnancy outcomes is seen in the literature. When it comes to the link of disease related to periodontium to that of adverse pregnancy outcomes, a need can arise if a significant cause-effect relationship does exist or not between them. Aim: The study was aimed to determine the association of periodontal health status in pregnant women with the occurrence of preterm low birth weight (LBW) infants in Vadodara, Gujarat. Settings and Design: An interventional study with 100 patients was conducted, of which 67 participants were included in the control group and 33 participants were included in the intervention group. A total of 12 participants dropped out from the study and 88 were analyzed for the outcome. Subjects and Methods: The Community periodontal Index of Treatment needs index was taken for all enrolled participants and then were divided into interventional group and control group. Participants in the interventional group underwent scaling and root planning. Data related to the time of delivery and weight of the baby was taken from the hospital records. Statistical Analysis: A comparison of baseline characteristics was made using unpaired t-test. Chi-square test was used for the analysis of intergroup comparison. The odds ratio and the relative risk calculation were also done. P ? 0.05 was considered for statistical significance. Results: The odds ratio for both preterm and LBW were 3.86 times and 2.96, respectively. The Chi-square statistical test analysis was statistically significant for both preterm and LBW infants on the intergroup comparison. Conclusion: Periodontal disease can be considered as one of the risk factors for preterm LBW babies as not only the presence of disease condition causes an increase in inflammatory mediator but also the elimination of the disease condition reduces the adverse pregnancy outcomes.
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The oral and craniofacial defect reconstruction has been a daunting task for several decades. Many clinicians have attempted to switch surgical techniques in flap transfer to enhance the purposeful outcomes. In many cases, however, near total restoration of the native anatomy is not achievable. Also, the normal functional performance is not attainable, regardless of the surgical technique used. This problem is more evident within the oral and craniofacial region considering the importance of functions, such as speech, chewing, and appearance. Stem cells have attracted a growing interest within the scientific community chiefly for their ability to regenerate broken tissues and conjointly for their known potential in modulating inflammatory and immune responses. These skills have caused stem cells to be thought about as a promising strategic tool for a range of clinical maxillofacial applications. In this review, authors briefly summarize the applications of stem cells in maxillofacial surgery.
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Background: It is the fact that, India consists of world’s largest tobacco chewer population, more prevalent in low income group. The effects of tobacco chewing on semen parameters have been widely studied. The study aim is to analyze the semen analysis parameters (oligozoospermia, asthenozoospermia, teratozoospermia, oligo-astheno-teratozoospermia -OATS and azoospermia) of tobacco chewer and non chewer infertile patients.Methods: A retrospective analysis of 639 patients was done out of which 150 were non-chewers and 489 were tobacco chewers. The percentage of population with particular semen abnormalities were compared between the two groups. The same comparison was performed between tobacco chewing primary infertility and secondary infertility patients in order to specifically assess the effect of tobacco chewing in sub-fertile patients.Results: OATS and azoospermia cases were significantly higher in the tobacco chewing infertile patients as compared to oligozoospermia, asthenozoospermia and teratozoospermia cases. In case of sub-fertile patients also, the percentage of OATS and azoospermia were significantly higher.Conclusions: This finding suggest that tobacco chewing greatly affects every parameter of sperm i.e. concentration, motility and morphology collectively. Moreover, tobacco chewing may be less affecting the male fertility initially but prolonged exposures affects detrimentally resulting in serious semen parameter abnormalities such as OATS and even azoospermia. And such cases are difficult to treat even with higher and advanced infertility treatment options like ICSI, microfludics, etc. This reduces the chances of IVF success as well as increases the financial burden on the patients undergoing infertility treatment. Thus, infertility clinics must employ awareness programs for such patients to explain them the effects of tobacco chewing habit and reducing it can definitely enhance the treatment outcomes.
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A 71- year- old male patient who was admitted with sudden loss of consciousness followed by slurring of speech and weakness of left side of the body and swelling on left side of the neck with the previous history of cerebrovascular accident (infarct). Patient was a known case of diabetes mellitus and hypertension and atrial fibrillation
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Background: Acute Normovolemic Hemodilution (ANH) and autologous transfusion can mitigate the harmful effects of banked blood intraoperatively. This study was planned to evaluate its effects on perioperative transfusion requirement, hemodynamic stability and safety profile.Methods: Hundred patients were randomized to Group 1, where assigned patients received ANH and autologous transfusion after hemostasis; and Group II where assigned patients received homologous transfusion. In group I, 350 to 700 ml of patient's blood was collected before induction of anaesthesia and was kept in the operation theatre at room temperature. This was followed by rapid infusion of calculated Hetastarch. Intraoperative blood loss, amount of transfused blood, serial haemoglobin (Hb) assessment, and change in hemodynamics were carefully monitored. The blood was reinfused once hemostasis was secured at the end of surgery.Results: It was observed that hemodynamic stability was maintained in both the groups during and after haemodilution. There was no significant change in bleeding and clotting time due to haemodilution. The mean intra-operative blood loss in both groups was comparable. 350 mL and 700 mL blood withdrawn in 27 and 23 patients and 500mL and 1000 mL HES infused respectively. There was an average fall in the mean Hb level by 1.74 gm % and in the mean haematocrit (Hct) level by 6.4 % after haemodilution. The mean 12th and 24th hour Hb and Hct levels were comparable. The requirement of homologous blood transfusion in group I was significantly low (p<0.0001). Need for homologous transfusion was 0.72 per patient treated in the Group I.Conclusions: Acute normovolemic hemodilution is a simple, safe and effective modality to reduce perioperative transfusion of banked blood and should be considered in patients undergoing surgical procedures where major blood loss is expected.
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Background: Shoulder Impingement is one of the most common causes of shoulder pain in adults. Scapular muscle imbalances results in impaired scapular orientation with altered scapular kinematics and altered glenohumeral rhythm. Purpose of study: To study the effect of motor control retraining of scapular stabilizers versus mulligan mobilisation with movement in shoulder impingement patients. Methodology: 60 patients with positive Hawkins, kinetic medial rotation and/or Neer impingement test were taken for the study as subjects. They were then divided into two groups of 30 each- Group A and Group B. Both the groups were assessed and reassessed for(i) pain status using VAS (Visual Analogue Scale) both at rest and on internal rotation, (ii)Shoulder Flexion, Extension, Shoulder Abduction, Adduction, Internal and External Rotation Range Of Motion (ROM), (iii)Functional Scale SPADI( Shoulder Pain and Disability Index) pre and post the intervention. Group A received motor control retraining of scapular stabilizers whereas group B received Mulligan’s mobilization with movement for 6 weeks (3 times in a week). Both the groups received conventional physiotherapy. Data analysis was done using Wilcoxon sign ranked test for intragroup comparison and Manwhitney test for intergroup comparison. Results: The results showed statistically significant improvement in shoulder pain, ROM and shoulder function in motor control retraining as compared to mulligan mobilisation with movement. Conclusion: Motor control retraining of scapular stabilizers is more effective treatment technique as compared to mulligan mobilisation with movement in shoulder impingement.
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Background: In the last decade different minimally invasive modalities for management of urolithiasis have been available requiring an intelligent decision by the urologist to choose one as per patients need and preferences.Methods: The present cross sectional study was conducted among patients who underwent ureterorenoscopic lithotripsy for proximal ureteric stones in the Department of Urology. Using consecutive sampling technique, patients were randomly allocated to two groups for treatment with either pneumatic lithotripser (group A) or Holmium laser lithotripser for fragmentation of calculi (group B) and the comparison of both these techniques was done.Results: 117 patients were included (57 and 60 in group A and group B respectively) in the study. The difference in age in the two groups was found to be statistically significant (p=0.03). The total operative time, length of stay in hospital and complications were more in group A patients. The difference in two groups for total operative time and length of stay in hospital was statistically significant (p=0.00 and 0.00 respectively).Conclusions: Holmium laser lithotripser has better safety profile when compared to pneumatic lithotripser especially in stone clearance rate and retropulsion rates and could be used as modality of choice in proximal ureteric stones.
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Purpose@#The coronavirus disease 2019 (COVID-19) pandemic has brought the world to a standstill and has exposed the lack of preparedness of most nations’ health care sys-tems. Even in usual times, palliative care has not received its fair share of recognition as an important component of patient care; instead, the emphasis is often placed on aggressive patient management. Now, with the entire medical community and decision-making committees focussed on intensive patient care, end-of-life care has taken a backseat. @*Methods@#This article is a brief communication. @*Results@#COVID 19 infection has been shown to lead to greater mortality and morbidity in patients with pre-existing illnesses such as hypertension, diabetes, renal failure, and cancer. Patients typically in need of end-of-life care, such as those with late-stage cancer or heart failure, are therefore at a higher risk of both contracting COVID-19 and suffering a more severe disease course. The strict nationwide lockdowns being imposed in most countries have deterred patients from seeking medical attention or hospice care. Every day new research is coming to light regarding COVID 19. This has helped significantly in creating awareness and limiting the spread of disease. However, misinformation is also rampant, leading to discrimination and mistreatment of infected patients. @*Conclusion@#This pandemic has been a terrifying ordeal for all and has exposed our entire population physically, psychologically, emotionally, and financially to unimaginable stresses. In the present scenario, EOL care is as much a necessity as intensive care and should be given at least a fraction of its importance.