Measures to Improve In?Hospital Outcomes of Patients Undergoing Surgical Repair for Anomalous Origin of Left Coronary Artery from Pulmonary Artery

Background:Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital anomaly leading to progressive left ventricular dysfunction and mitral regurgitation. We conducted this study to investigate various measures to optimize the outcomes of surgical correction for ALCAPA. Materials And Methods: This was a single?centre, retrospective, observational study including consecutive patients operated for ALCAPA. The main outcomes evaluated were in?hospital mortality, duration of mechanical ventilation, and duration of intensive care unit (ICU) stay. Independent sample t? test and Fisher’s exact test were used for the analysis of continuous and categorical variables respectively. Results: 31 patients underwent surgical correction for ALCAPA during the study duration. The median age was 7.3 months with a range of 21 days to 25 months. All patients underwent coronary re?implantation with the coronary button transfer technique. There was no in?hospital mortality, the mean duration of mechanical ventilation and ICU stay was 117.6 hours and 10.7 days respectively. Age at admission, development of acute kidney injury after surgery, lactate levels at 12? and 24?hours post?surgery, and heart rate at ICU admission and 12?hours post?surgery were significantly associated with mechanical ventilation duration longer than 48 hours. Use of a combination of levosimendan and milrinone and elective intermittent nasal continuous positive airway pressure ventilation after extubation in all patients with severe left ventricular dysfunction were helpful in preventing low cardiac output and need for reintubation post?surgery respectively. Conclusion: Surgical correction for ALCAPA by coronary re?implantation has an excellent short?term outcome. Optimal postoperative management is of utmost importance for achieving the best results.

Aetiological Profile of Anaemia in Elderly at a Tertiary Care Centre

Anaemia is a common clinical condition in elderly commonly associated with increased morbidity and mortality, increased hospitalization, decreased physical performance, loss of mobility and disability at higher rates than those people without anaemia. The present study was undertaken to assess the aetiological profile of anaemia in elderly. METHODSA cross sectional study was done among elderly patients with anaemia admitted in general medicine department and / or attending general medicine OPD, IGIMS, Patna, Bihar. 100 consecutive patients were selected as per inclusion and exclusion criteria. The patients were subjected to a thorough clinical examination and investigation, and data was analysed. RESULTSAnaemia is more common in males with a male to female ratio of 2.84:1. Maximum numbers of cases was in the age range of 61 to 70 comprising 70 % followed by 23 % in 71 to 80 years age group and 6 % in 81 to 90 years age group. Weakness was the most common presentation comprising 74 % cases. Comorbidities in patients along with anaemia were solid malignancy in 5 %, diabetes mellitus (DM) in 7 %, hypertension (HT) in 6 %, chronic kidney disease (CKD) in 5 %, cor pulmonale in 3 % and hypothyroidism in 1 %. 48 % patients were having moderate anaemia and 45 % patients were having severe anaemia. Morphologically most common variety of anaemia was normocytic normochromic contributing 57 % of the patients. Bone marrow examination done in 62 cases revealed hyper cellular marrow in 27, normocellular in 24, hypo cellular marrow in 6 and mildly hyper cellular to normocellular in 5 cases. Aetiological distribution showed 14 % of anaemia of chronic disease (ACD) and 14 % due to vitamin B12 deficiency. This was closely followed by iron deficiency anaemia (IDA) in 13 % cases. CONCLUSIONSAnaemia in elderly is a common clinical condition commonly presenting with nonspecific symptom. Normocytic normochromic anaemia is the most common morphological type of anaemia with various underlying treatable aetiologies.

Study of Urinary Tract Infection in Patients with Diabetes Mellitus

Introduction: Urinary tract infection is one of the most common types of bacterial infection in patients with diabetes mellitus.Aim: The aim of the study was to assess the prevalence of urinary tract infection among hospitalized diabetic patients.Materials and Methods: A hospital-based prospective study was carried out from June 2018 to May 2019. A total of 100 patientsof diabetes mellitus with urinary tract infection were included in this study.Results: Of 100 patients, 54 were male and 46 were female, the most common age group was 46–55 years. Most patientshad a fever with rigor (48%) followed by dysuria (22%), suprapubic pain (20%), increased frequency of urine (18%), flank pain(10%), pyuria (6%), and hematuria (4%). Urine culture analysis revealed that Escherichia coli (29%) was the most commonorganism responsible of urinary tract infection. The majority of isolated organisms were sensitive to antimicrobial agents suchas amikacin, nitrofurantoin, and levofloxacin.Conclusion: Urinary tract infection is frequent in diabetic patient and the urine culture should be performed in all hospitalizedpatients with diabetes mellitus. Early diagnosis, knowledge of common predisposing factors, and appropriate clinical managementare important to improve prognosis.

Level of C-reactive Protein in Obese and Overweight Individuals at Indira Gandhi Institute of Medical Sciences: A Tertiary Care Center of Bihar

Introduction: Human adipose tissue releases interleukin-6 which is a pro-inflammatory cytokine that causes low-grade systemicinflammation. Acute-phase C-reactive protein (CRP) is a sensitive marker for systemic inflammation. Low-grade systemicinflammation in overweight and obese can be measured by serum CRP level.Objective: The objective of this study was to find out the prevalence of raised serum CRP level among the obese and overweightperson.Materials and Methods: Overweight and obese persons were screened for raised CRP (≥3.0 mg/L) after excluding comorbidity.Results: The prevalence of raised CRP among obese and overweight is 23%, the female has higher prevalence of 25.45% ascompared to male 20%. The prevalence among overweight and obese participants is 18.88% and 60%, respectively.Conclusions: The finding suggest a higher prevalence of low-grade systemic inflammation in obese as compared to anoverweight person.

Type ii aortopulmonary window with isolated left subclavian artery from left pulmonary artery

Abstract Type II Aortopulmonary window (APW) accounts for only 10% of total cases of APW, which by itself is a rare congenital anomaly. Various cardiac malformations have been reported to be associated with this rare anomaly. We report one such association of origin of left subclavian artery (LSCA) from left pulmonary artery (LPA) via ductus arteriosus that was surgically repaired.

Assessment of Cases of Peri- Implantitis- A Clinical Study

Background: The present study was conducted to evaluate peri- implantitis around dental implants. Methods: The present retrospective study was conducted on 60 patients of both genders with 90 dental implants. Pocket depth (PD) around the implant and around the teeth adjacent to the implant was calculated. Gingival recession (GR) was calculated. Clinical attachment loss (CAL) was calculated by adding GR and PD. Intraoral periapical radiographs (IOPAR) were taken to evaluate peri- implantitis. Results: Out of 60 patients, males were 35 and females were 25. In 35 males, 45 dental implant and in 25 females, 45 dental implants were present. The mean probing depth (PD) around implant was 4.26± 1.20 and adjacent teeth was 3.40± 1.32. The difference was significant (P- 0.01). Gingival recession (GR) around implants was 0.56± 0.98 and adjacent teeth was 0.86± 1.35 (P- 0.02). Clinical attachment loss (CAL) found to be 4.26± 1.32 around implant, 4.03± 1.32 around adjacent teeth. The difference was non- significant (P- 0.07). Conclusion: Periodontal diseases affect the outcome of dental implant treatment. Thus periodontal status should be healthy especially in the region adjacent to implant site.

Study of Clinical Profile of Acute Undifferentiated Fever in a Tertiary Care Hospital

Introduction: Major aetiology of acute undifferentiated fevershows wide variation, especially in developing countriesincluding India. Acute undifferentiated fever poses a diagnosticand therapeutic challenges to health care workers, particularlyin limited resources. It is one of the commonest presentingproblem in hospital. It is necessary to know the cause, whichwill be useful to give proper treatment to the patients. Thisstudy was aimed to find out the acute undifferentiated feveraetiologies and clinical pattern.Material and Methods: This study was conducted onhundred patients of acute undifferentiated fever, admittedin Indira Gandhi institute of Medical Science, Patna fromFebruary 2018 to January2019.Result: Acute undifferentiated fever affected all age groupbut most common in 26 to 35 years of age group (29%).One hundred patients were included, 78male and 22female.In this study, Typhoid (41%) was leading cause of acuteundifferentiated fever followed by Malaria (23%), DengueFever (20%), Leptospirosis (5%), Scrub Typhus (3%) andChikungunya (1%). Common symptom was fever (100%),Headache (64%), Vomiting (48%), Rigor and chills (42%)whereas common sign was hepatosplenomegaly (55%).Typhoid fever (41%) was the commonest cause of acuteundifferentiated fever followed by malaria (23%), denguefever (20%), urinary tract infection (5%), scrub typhus (3%)and chikungunya (1%).Conclusion: It is important to know the aetiology andclinical pattern of acute undifferentiated fever for theirproper management and it will help to prevent morbidity andmortality.

Common morbidities and felt needs of salt pan workers in a coastal area of Tamil Nadu, India

Background: The occupational hazards faced by salt pan workers during their occupation are myriad, a fact compounded by the lack of basic amenities at their workplace and lack of awareness regarding usage of personal protection equipment.Methods: This cross-sectional study was carried out among fifty-six salt pan workers in Marakkanam, Tamil Nadu to assess their common health problems and a qualitative component was added to assess their felt needs in work place and daily living. Data was collected using pre-designed data collection sheet for assessing the common morbidities. For the qualitative aspect of the study, in-depth interviews were conducted among twenty workers based on convenient sampling, using open ended questions. Data was collected after obtaining informed consent and steps were taken to ensure confidentiality at all stages.Results: The most common health problem of the workers in present study area included dental caries (41.7%), skin conditions (38.1%) musculoskeletal problems (36.7%) and anemia (35.1%) being other significant health problems. The qualitative aspect of the study revealed that the felt needs were improvement of their working conditions and more social support from the Government and the employers. There was very little awareness among the workers regarding use of PPE and none of them used any form of PPE.Conclusions: Salt pan workers had dental problems, dermatological problems and musculoskeletal problems as most common morbidities among them. Harsh working conditions, financial insecurity etc. are some of their work-related problems. Provision of housing facility and financial assistance during off- season by the government, basic amenities at the work place, paid leave in case of injuries, and insurance schemes for them by employer are their main felt needs. They also had no awareness regarding usage of personal protective equipment at the work place.

Determinants of posterior capsular opacity after cataract surgery: a cross-sectional study

Background: Posterior capsular opacification (PCO) which is also known as “after cataract” or “secondary cataract”, is the most common complication of cataract surgery, with an incidence of 20-50%. The current study was conducted in a tertiary hospital of Odisha with an objective to find out the determinants of PCO among patients with defective vision attending the outdoor patient department of Ophthalmology.Methods: A hospital based descriptive study was conducted among the patients attending the ophthalmology out patient department of a tertiary hospital of Odisha. The detail history regarding the type of surgical procedure used for cataract extraction and the type of Intra Ocular Lens (IOL) implanted, duration of post-operative period was collected from the available documents and ophthalmic examination of the participants.Results: In the present study, 184 participants were included and examined. Fifty percent of the participants had undergone conventional extra capsular cataract extraction procedure. In 86.95% participants, the IOL used was Poly Methyl Methacrylate lens (PMMA). In 26.08% of the participants the development of PCO was within 12 to 36 months of cataract surgery. The average duration of PCO development recorded for participants <20 years was 3 months.Conclusions: Most of the participants included in the study with PCO had undergone conventional ECCE surgery, implanted PMMA lens, IOL with round edge and had a duration of 12-36 months between cataract surgery and PCO development. The average duration of PCO development is less among younger participants which gradually increases with increase in age.

Safety and efficacy of Nd:YAG laser capsulotomy in management of posterior capsular opacification

Background: At present, the only effective treatment of posterior capsular opacification (PCO), which is the most common complication of modern cataract surgery, is Neodymium-Yttrium Aluminum Garnet (Nd:YAG) laser capsulotomy. There are few complications associated with this easy and quick laser capsulotomy. The current study was conducted in a tertiary hospital of Odisha with an objective to find the safety and efficacy of Nd:YAG laser capsulotomy in the management of defective vision due to posterior capsular opacity.Methods: The study was conducted among the patients attending the Ophthalmology out patient department of a tertiary hospital in Odisha with defective vision due to posterior capsular opacity after cataract surgery. Nd:YAG laser capsulotomy was carried out in all patients with significant PCO. Visual acuity and intraocular pressure were recorded before and after the procedure. The cases were carefully followed up and looked for any complication and visual acuity was assessed during follow up visits.Results: In the study 184 participants were included. Visual improvement was observed in 97.8% participants. Visual acuity improved to 6/6 in 21.73 %, 6/9 in 36.41 % cases, 6/12 in 15.21 % cases. Raised IOP was recorded among 46% of participant after 4 hrs of laser capsulotomy which was later observed among 12% of participants on follow up visit at 1 week. The most common complication recorded was transient rise of IOP (46.3%) followed by aqueous flare (28.8%).Conclusions: Nd:YAG laser capsulotomy is a noninvasive, effective, relatively safe procedure for PCO with good visual outcome.

Anterior minithoracotomy: a safe approach for surgical asd closure & asd device retrieval

Abstract Objective: Midline sternotomy is the preferred approach for device migration following transcatheter device closure of ostium secundum atrial septal defect. Results of patients operated for device migration were retrospectively reviewed after transcatheter closure of atrial septal defect. Methods: Among the 643 patients who underwent atrial septal defect with closure device, 15 (2.3%) patients were referred for device retrieval and surgical closure of atrial septal defect. Twelve patients underwent device retrieval and surgical closure of atrial septal defect through right antero-lateral minithoracotomy with femoral cannulation. Three patients were operated through midline sternotomy. Results: Twelve patients operated through minithoracotomy did not require conversion to sternotomy. Due to device migration to site of difficult access through thoracotomy, cardiac tamponade and hemodynamic instability, respectively, three patients were operated through midline sternotomy. Mean aortic cross-clamp time and cardiopulmonary bypass time were 28.1±17.7 and 58.3±20.4 minutes, respectively. No patient had surgical complication or mortality. Mean intensive care unit and hospital stay were 1.6±0.5 days and 7.1±2.2 days, respectively. Postoperative echocardiography confirmed absence of any residual defect and ventricular dysfunction. In a mean follow-up period of six months, no mortality was observed. All patients were in New York Heart Association class I without wound or vascular complication. Conclusion: Minithoracotomy with femoral cannulation for cardiopulmonary bypass is a safe-approach for selected group of patients with device migration following transcatheter device closure of atrial septal defect without increasing the risk of cardiac, vascular or neurological complications and with good cosmetic and surgical results.

Transposition of Great Arteries with Intramural Coronary Artery: Experience with a Modified Surgical Technique

Abstract Objective: Transposition of the great arteries is a common congenital heart disease. Arterial switch is the gold standard operation for this complex heart disease. Arterial switch operation in the presence of intramural coronary artery is surgically the most demanding even for the most experienced hands. We are presenting our experience with a modified technique for intramural coronary arteries in arterial switch operation. Methods: This prospective study involves 450 patients undergoing arterial switch operation at our institute from April 2006 to December 2013 (7.6 years). Eighteen patients underwent arterial switch operation with intramural coronary artery. The coronary patterns and technique used are detailed in the text. Results: The overall mortality found in the subgroup of 18 patients having intramural coronary artery was 16% (n=3). Our first patient had an accidental injury to the left coronary artery and died in the operating room. A seven-day old newborn died from intractable ventricular arrhythmia fifteen hours after surgery. Another patient who had multiple ventricular septal defects with type B arch interruption died from residual apical ventricular septal defect and sepsis on the eleventh postoperative day. The remainder of the patients are doing well, showing a median follow-up duration of 1235.34±815.26 days (range 369 - 2730). Conclusion: Transposition of the great arteries with intramural coronary artery is demanding in a subset of patients undergoing arterial switch operation. We believe our technique of coronary button dissection in the presence of intramural coronary arteries using coronary shunt is simple and can be a good addition to the surgeons' armamentarium.

Acceptance And Impact Of Integrated Teaching In Undergraduate Medical Student: An Observational Cross- Sectional Study.

Background & Objective: Among various method of medical education integrated teaching help in integration of basic, clinical and psychosocial sciences. Integrated teaching involves bringing together traditionally separate subjects so that students can grasp subject with more authentic understanding. We conducted the study to compare this scientific method of teaching with traditional learning and also obtained student’s and teacher’s feedback. Methodology: After approval from ethic committee faculty members from various departments we arranged integrated teaching program on important topic. Basic science faculty were made toparticipate actively in both case based learning and hospital visits along with clinical experts. The completed program was evaluated based on structured questionnaire and student and teacher feedback. Results: Among 58 students of 8th semester students, Pre test (TL) and post test (IL) mean of incorrect answers out of 10 structured questionnaires were 4.5517 and 2.9310. There was 35.5% improvement in result after integrated method of learning. 63% of faculty members felt that integrated teaching could be very useful. 85% students were enthusiastic about the new teaching methodology& felt that they had a better clinico pathological correlation. Conclusion: The new method of integrated teaching was found to be more effective than the traditional one. This method was well accepted by faculty as well as students. So it is need of today’s medical curriculum.

Individual and interactive effects of elevated carbon dioxide and ozone on tropical wheat (Triticum aestivum L.) cultivars with special emphasis on ROS generation and activation of antioxidant defence system.

The effects of elevated CO2 and O3, singly and in combination were investigated on various physiological, biochemical and yield parameters of two locally grown wheat (Triticum aestivum L.) cultivars (HUW-37 and K-9107) in open top chambers (OTCs). Elevated CO2 stimulated photosynthetic rate (Ps) and Fv/Fm ratio and reduced the stomatal conductance (gs). Reactive oxygen species, lipid peroxidation, anti-oxidative enzymes, ascorbic acid and total phenolics were higher, whereas Ps, gs, Fv/Fm, protein and photosynthetic pigments were reduced in elevated O3 exposure, as compared to their controls. Under elevated CO2 + O3, elevated levels of CO2 modified the plant performance against O3 in both the cultivars. Elevated CO2 caused significant increase in economic yield. Exposure to elevated O3 caused significant reduction in yield and the effect was cultivar-specific. The study concluded that elevated CO2 ameliorated the negative impact of elevated O3 and cultivar HUW-37 was more sensitive to elevated O3 than K-9107.