Transthoracic echocardiographic analysis of moderate to severe COVID-19 patients admitted to ICU at tertiary hospital in India

Background:To describe the transthoracic echocardiographic findings of moderate to severe COVID-19 patients admitted to ICU.Methods: We studied thetransthoracic echocardiographic findings performed within 48 hours on admission toICU of 426 moderate to severe COVID-19 patients from July 2020 to September 2020 during their course of treatment. Echocardiographic study included left ventricular (LV) systolic and diastolic function, left ventricle wall motion abnormalities and right ventricular (RV) assessment.Results: The median age of patients was 58.2 (range 19 to 92 years) and majority of patients were male (71%). Pre-existing comorbidities were reported in 95.5% of patient’s, majority being hypertension (42.7%) and diabetes mellitus (39.2%).Abnormal echo findings were noted in 40.8% (n=174) with majority of abnormal findingsnoted in age group of 60-69 (n=54), men (n=114) and in patients with pre-existing coronary artery disease (CAD)(n=28). The common pattern of cardiac abnormalities was LV systolic dysfunction (n=73, 17.1%), RV dysfunction (n=30, 7%) and abnormal PA pressures (n=144, 85.2%). Abnormal echo findings were noted in 46% of patients who died and 33.9% of patients who required hospital stay of more than 10 days.Conclusions:Forty percent of admitted patients to ICU had abnormal echocardiography findings with around eighty five percent of them having raised pulmonary artery pressure

Seizure in the emergency department: Finding the zebra among the horses

Aortic dissection (AD) is a life-threatening emergency that mandates early and precise diagnosis. Seizure as an initial and exclusive manifestation of AD is extremely rare. The prevalence of this is sparsely available in the literature. We report the case of a 68-year-old male patient where the patient presented with seizures and discrepancy of blood pressures in the upper limbs. AD was suspected in this case with an atypical presentation

Prevalence of Tobacco and associated risk factors among university law students in Indore City

Introduction: Tobacco use is one of the major preventable causes of death and disability worldwide. The practice of law can be demanding and exceedingly stressful. Trends in tobacco use among young people are important to document because these findings will help inform the development of appropriate preventive intervention programs for youth. Aim: To assess prevalence of tobacco and associated risk factors among university law students in Indore city. Objective: To identify the strength of association related to tobacco consumption. Materials and Methods: A descriptive cross-sectional study was conducted among 278 law students in Indore city using convenient sampling technique. The data was collected using pre-tested close ended self-administered questionnaire. Frequency distribution analysis was performed. Bivariate analysis was done followed by logistic regression analysis. The level of significance for all the tests was set at P < 0.05. Results: The present study revealed that 32% of the study subjects consumed smoking tobacco as compared to 2.5% of smokeless tobacco. Nearly two-third of the law students consumed tobacco at public places 185 (66.5%) under the influence of friends. Only 18 (6.5%) study subjects tried to quit tobacco in the last 12 months whereas 65 (23.4%) of them never wanted to quit the habit of tobacco consumption. A bivariate analysis was performed to identify the risk factors related to tobacco consumption. It was found that male individuals (OR=2.04, P =0.004*) whose family members had the habit of tobacco consumption (OR=2.9, P =0.002*) were at a higher risk for consuming tobacco. The factors that became significant in bivariate analysis were then entered in logistic regression analysis [Enter method] to identify the strength of association. The individuals who had the habit of tobacco consumption among family members emerged as the strongest risk predictor leading to tobacco consumption amongst the students. Conclusion: The present study revealed that smoking form of tobacco consumption (cigarette- 32%) was more prevalent among the male study subjects under the influence of friends and with family members who had the habit of consuming tobacco at their place of residence.

The change of COX-2 expression in rats with stress urinary incontinence and its significance / 医学研究生学报

Objective　There are a few researches on the mechanism of stress urinary incontinence (SUI). The article aimed to examine the changes of COX-2 expression in the urethra, vagina and urethral smooth muscle of SUI rat mode to evaluate the effect of estrogen on COX-2 expression. Methods　Sixty unbearing healthy female SD rats and fifteen male SD rats were gathered for spontaneous delivery. SUI rat models were constructed using expanded vagina, expanded vagina + ovariectomy respectively after delivery, which were expanded vagina group and expanded vagina + ovariectomy group. Six successfully modeled rats were chosen for the follow-up experiment. SD rats modeled after normal pregnancy were the control group. Sneezing experiment and urodynamic examination were used to examine the maximum bladder capacity (MBC) and abdominal leak point pressure (ALPP). Fluorescent quantitative PCR and western blot were applied to detect the expressions of COX-2 mRNA and protein, and immunohistochemistry was used to detect the expressions of COX-2 in urethra, vagina and urethral smooth muscle. Results Compared with control group, ALPP in two experimental groups were significantly decreased, among which ALPP in expanded vagina + ovariectomy group was significantly decreased in comparison to expanded vagina group(P<0.05). Compared with control group, the expressions of COX-2 mRNA and protein in expanded vagina group and expanded vagina+ovariectomy group were significantly higher, among which the figures in expanded vagina+ovariectomy group were significantly higher than those in expanded vagina group(P<0.05). The result of immunohistochemistry showed staining intensity integral expression of COX-2 in vaginal tissues of control group, expanded vagina group and expanded vagina+ovariectomy group were 0.50±0.54, 5.55±0.54, 9.33±0.81, so differences between any two groups were of statistical significance(P<0.05); staining intensity integral expression of COX-2 in urethral smooth muscle of control group, expanded vagina group and expanded vagina+ovariectomy group were 0.66±0.51, 5.33±0.51, 8.50±0.54, so differences between any two groups were of statistical significance (P<0.05). Conclusion The expression of COX-2 was related to the mechanism of SUI. The decrease of estrogen may increase the expression of COX-2 in SUI rats, which supports the treatment of SUI.

Relationship between high red cell distribution width and systemic inflammatory response syndrome after extracorporeal circulation

Abstract Objective: Cardiac surgical operations involving extracorporeal circulation may develop severe inflammatory response. This severe inflammatory response syndrome (SIRS) is usually associated with poor outcome with no predictive marker. Red cell distribution width (RDW) is a routine hematological marker with a role in inflammation. We aim to determine the relationship between RDW and SIRS through our study. Methods: A total of 1250 patients who underwent cardiac surgery with extracorporeal circulation were retrospectively analyzed out of which 26 fell into the SIRS criteria and 26 consecutive control patients were taken. RDW, preoperative clinical data, operative time and postoperative data were compared between SIRS and control groups. Results: The demographic profile of the patients was similar. RDW was significantly higher in the SIRS versus control group (15.5±2.0 vs. 13.03±1.90), respectively with P value <0.0001. There was significant mortality in the SIRS group, 20 (76.92%) as compared to 2 (7.6%) in control group with a P value of <0.005. Multiple logistic regression analysis revealed that there was significant association with high RDW and development of SIRS after extracorporeal circulation (OR for RDW levels exceeding 13.5%; 95% CI 1.0-1.2; P<0.05). Conclusion: Increased RDW was significantly associated with increased risk of SIRS after extracorporeal circulation. Thus, RDW can act as a useful tool to predict SIRS in patients undergoing cardiac surgery with extracorporeal circulation. Hence, more aggressive measures can be taken in patients with high RDW to prevent postoperative morbidity and mortality.

A concomitant intramyocardial and pulmonary hydatid cyst: a rare case report

Abstract Cardiac hydatid cyst is an uncommon but potentially fatal disease. In cystic Echinococcus humans are an accidental host. Liver and lungs are the most frequently involved organs. Herein a unique case of intramyocardial hydatid cyst of left ventricle along with pulmonary hydatid cyst in a 38-year-old lady is reported. Surgical removal of the cardiac hydatid cyst was done with the aid of cardiopulmonary bypass followed by removal of pulmonary hydatid cyst.

Assessment of relationship between oral health behavior, oral hygiene and gingival status of dental students.

Background: The behavior of oral health providers toward their own oral health reflects their understanding of the importance of preventive dental procedures and of improving the oral health of their target population. Aim: This study was done with an aim to assess the relationship between oral health behavior, oral hygiene and gingival status of third and final year dental students from a Dental College in Indore City, India. Methods: A total of 137 dental students participated in the study. The students were invited to complete the Hiroshima University‑Dental Behavioral Inventory (HU‑DBI) questionnaire. The HU‑DBI questionnaire consisted of twenty polar responses (agree/disagree) regarding oral health‑related behavior. In addition, two further questions about the frequency of brushing and flossing were included. Subsequently, oral health examination was conducted to assess plaque and gingival status. Data were analyzed using Chi‑square test, Independent sample t‑test, and Pearson’s correlation. The significance level was set at P ≤ 0.05. Result: The results showed that about 66.6% of the students checked their teeth in the mirror after brushing. Only 20.1% of the students reported bleeding from gums. The mean oral heath behavior score (HU‑DBI) was 6.47 ± 2.0. A negative correlation of HU‑DBI scores with plaque (r = −0.501) and gingival scores (r = −0.580) was observed. Conclusion: Thus, it is concluded that there is a significant relationship between the oral health behavior, oral hygiene, and gingival status of dental students. Dental students with better self‑reported oral health behavior had lower plaque and gingival scores indicating a better attitude toward oral health.

Epidural bupivacaine combined with dexmedetomidine or clonidine in infraumbilical surgeries: a comparative evaluation.

Background: Alpha-2 agonist are being extensively evaluated as an alternative to neuraxial opoids, as an adjuvants in regional anaesthesia The faster onset of action of local anaesthetics, rapid establishment of both sensory and motor blockade, prolonged duration of analgesia into postoperative period, dose sparing action of local anaesthetics and stable cardiovascular parameters make these agents a very effective adjuvant in regional anaesthesia. Methods: Our study had 45 patients, all patients belonged to ASA Grade-I or II, between 20 and 55 years of age with an average height of 150 and 170 cm and have ideal body weight requiring neuraxial blockade for lower abdominal surgeries. All the patients were randomly allocated into two groups Group-I: Epidural bupivacaine 0.5% (16 ml) + clonidine 75 μgm (1 ml) Group-II: Epidural bupivacaine 0.5 % (16 ml) + Dexmedetomidine 50 μgm (1 ml) Patients were monitored for sensory and motor blockade, hemodynamic parameters, rescue analgesia, sedation and adverse effects in perioperative period. Results: The time of onset of sensory block at T10 and time to reach maximum sensory block (T6) in group-I was significantly longer as compared to group-II. The complete motor blockade (grade-3) was achieved much later and time taken for recovery to grade-0 was significantly shorter in group-I. The time for rescue analgesia in group-I was significantly shorter as compared to group-II. Hypotension was the most common side effect in both the groups. Dry mouth is a known side effect of alpha-2 agonists. Epidural dexmedetomidine produced profound sedation. Conclusions: We conclude from this study that dexmedetomidine is a better adjuvant than clonidine for providing early onset of sensory analgesia, superior sedative properties and prolonged post-operative analgesia.

Epidural ropivacaine combined with fentanyl or in combination with clonidine in infraumblical surgeries: a comparative study.

Background: The addition of an adjuvant, like clonidine and fentanyl, in epidural blockade has enhanced the effectiveness of local anaesthetics as they not only help in intensifying and prolonging the blockade effect but also help in the reduction of the dose of local anaesthetics. Methods: Our study had 45 patients, all patients belonged to ASA grade-I or II, between 20 and 55 years of age requiring neuraxial blockade for lower abdominal surgeries. All the patients were randomly allocated into two groups. Group-I: Epidural ropivacaine 0.75% (14.5ml) + Fentanyl 50 μgm (1 ml) + 0.5 ml distilled water. Group-II: Epidural ropivacaine 0.75% (14.5ml) + Fentanyl 50 μgm (1 ml) + clonidine 50 μgm. Patients were monitored for sensory and motor blockade, hemodynamic parameters, rescue analgesia and adverse effects in perioperative period. Results: Highest level of sensory and motor blockade was found to be insignificant (p>0.05) in both the groups. Mean time for regression of sensory blockade to T10 was significantly longer (p<0.05) in group II as compared to group I. The duration of motor blockade was significantly (p<0.001) higher in patients of Group-II as compared to Group-I. The addition of clonidine to epidural Ropivacaine and fentanyl (Group-II) produces longer duration of analgesia as compared to Group-I. Haemodynamically the patients in both the groups behaved similarly. The patients, in whom epidural fentanyl was used, had slightly higher incidence of nausea, vomiting, dry mouth and pruritus. Conclusions: So this study re-established the fact, that the fentanyl and clonidine when added as adjuvant to epidural ropivacaine, significantly prolongs the analgesic duration without causing significant hemodynamic and respiratory changes.

Prediction of morbidity and mortality in middle and old aged surgical patients-comparison of standard scoring system and addition of echocardiography with hemodynamic indices.

Background: A prospective study was carried out in our hospital to predict morbidity and mortality in middle and old aged surgical patients by adding echocardiography to standard scoring system with hemodynamic studies. Methods: A total of 50 patients of either sex ranging from 40-70 years of ASA grade 1 & 2 scheduled for various types of noncardiac surgeries were enrolled for the study in our hospital. Patients were divided in two groups according to echocardiographic examinations. The patients with normal echocardiographic values were kept in control group and the patients with abnormal values were kept under study group. The patients in study group were further divided in three groups according to LVEF. Group1-LEVF≥60%, Group2-LVEF≥50-59%, Gr3≥40-49% Tab lorazepam was given to all the patients’ orally prior night of surgery. All the patients were induced with same type inducing agents according to body weight. All the patients were maintained on IPPV by anaesthesia machine with supplemental fentanyl, N2O, O2 and muscle relaxant. SPO2, electrocardiograph (ECG), Non-invasive/invasive blood pressure (BP), Spirometry, Capnography and temperature were monitored. At the end of the research project data’s were compiled systematically and were subjected to statistical analysis using odd’s ratio(OR),95% confidence interval (CI), z value and p value, two statistical software programme were used. Results: Significant difference in the results seen between the three study groups (Gr1, Gr2, Gr3) for perioperative ischemic changes, CHF and arrhythmias. Conclusions: In conclusion preoperative TTE before non-cardiac surgery can predict the risk of perioperative cardiac complications in known or suspected cases of cardiac disease patients.

Prevalence of anterior teeth fracture among visually impaired individuals, India.

Aim: The aim of the study was to determine the prevalence of anterior teeth fracture among visually impaired individuals. Materials and Methods: A cross‑sectional study was carried out among 103 blind individuals (70 males and 33 females), with age ranges from 10 years to 29 years, the survey was carried out according to World Health Organization (WHO) criteria and by using WHO classification for teeth fracture. All subjects were divided into two groups on the basis of whether they are partially sighted or totally blind. Data were analyzed using Chi‑square test, with keeping the level of significance at P < 0.05. Results: Overall prevalence of 34.95% of traumatic injuries to anterior teeth was found in the study population with no significant difference between both groups (P < 0.05). Female were having significantly more fracture than males (P < 0.005). Fall being indoor was the most common cause. Permanent maxillary central incisors were most commonly injured with injuries involving enamel and dentin being the most frequently observed. Increased overjet and inadequate lip coverage were significantly associated with the occurrence of trauma (P = 0.0001). Conclusion: The prevalence of dental injuries in a group of individuals with blind. This should alert caregivers to carry out a profound investigation of the events and suggest methods to reduce this type of morbidity.