Tear film dysfunction after clear corneal phacoemulsification in diabetics and non-diabetics

Purpose: A prospective cohort study was conducted in a tertiary eye care centre to study the incidence of tear film dysfunction and its recovery in diabetics and non-diabetics after clear corneal phacoemulsification. Methods: A total of 50 diabetics and 50 non-diabetics underwent clear corneal phacoemuslfication. Schirmer’s I test (SIT), tear film break-up time (TBUT), corneal staining, tear meniscus height (TMH), and ocular surface disease index (OSDI) assessment were done preoperatively, postoperatively at 7 days, 1 month, and 3 months in both groups to assess tear film function. Results: Both groups showed decreased SIT and TBUT values on postoperative Day 7, after which they gradually improved. SIT and TBUT values in diabetics were significantly lower than that in non-diabetics postoperatively (P < 0.001). SIT in non- diabetics reached baseline levels at postoperative 3 months. OSDI scores reached peak levels in both groups on postoperative Day 7, but were higher in diabetics than non-diabetics (P < 0.001). OSDI scores gradually improved over 3 months but remained over baseline levels in both groups. Corneal staining was positive in 22% diabetics and 8% non-diabetics at postoperative Day 7. However, none of the patients had corneal staining at 3 months. Tear meniscus height (TMH) did not reveal any significant difference between the two groups at any time interval. Conclusion: We concluded that tear film dysfunction after clear corneal incision occurs in both groups, but is more severe and recovers more slowly in diabetics than non-diabetics.

A cross-sectional study on the prevalence of cardiovascular risk factors in police personnel of Karimnagar mandal

Introduction: Many studies showed that police officers complained about physical and mental health issues due to job stress. These work stresses lead to adop?ng unhealthy lifestyles and habits including the harmful use of alcohol and tobacco use which leads to high blood pressure, heart a?acks, and other NCDs. Methods: This cross-sec?onal study included all male police personnel of all cadres from nine police sta?ons of Karimnagar Mandal. WHO STEPS NCD survey ques?onnaires were used to collect basic soci-demographic informa?on, clinical history, stress, and anthropometry for measurements of CVD risk factors. Result: 253 police personnel with a mean age of 41.09 years enrolled from all cadres. 152 (60%) of police personnel had mul?ple cardiovascular risk factors. Hypercholesterolemia (37.2%) followed by a sedentary lifestyle (30.8%), and diabetes mellitus (14.6%) were important findings in this study. This study has also revealed an important link between preceding condi?ons for developing cardiovascular diseases such as pre-hypertension in 42.7% and impaired fas?ng glucose level in 25.7% of police personnel. Half of the study police personnel had a family history of NCDs and it was not sta?s?cally significant with service experience. There was a strong associa?on between years of experience and tobacco and alcohol use. Organiza?onal and opera?onal stress levels increased with the increase in years of experience in policing (p-value<0. 01). Conclusion: Smoking and alcohol consump?on were more prevalent among Police personnel which need to be controlled. Physical inac?vity was another important area. Their a?tude towards controlling the risk factors and prac?cing healthy behavior to safeguard from cardiovascular diseases has to be strengthened. It can be done by conduc?ng regular awareness camps, training sessions, and regular cardiac risk factor evalua?ons for all police personnel.

Estimation of surgically induced astigmatism after small-incision cataract surgery done by junior residents

Purpose: To estimate the postoperative astigmatism after small?incision cataract surgery (SICS) done by junior residents at the end of 1 and 3 months. Methods: This observational longitudinal study was conducted at the Department of Ophthalmology of a tertiary eye care hospital and research center. 50 patients enrolled in the study underwent manual small incision cataract surgery by junior residents. Preoperative detailed ocular examination was done, which included keratometric estimation using autokeratometer (GR?3300K). Incision length, distance of incision from the limbus, and type of suturing technique were noted. Postoperatively, keratometric readings were noted at 1 and 3 months. Astigmatism (surgically induced astigmatism [SIA]) was estimated using Hill’s SIA calculator version 2.0. All the analyses were performed using Statistical Package for the Social Sciences (SPSS) ver. 26.0 (IBM Corp., USA) software, and the statistical significance was tested at a 5% level. Results: Out of 50 patients, 54% had SIA between 1.5 and 2.5 D and 32% had SIA of more than 2.5 D. Only 14% had SIA less than 1.5 D at the end of 1 month. While 52% had SIA between 1.5 and 2.5 D, 22% had SIA between 1.5 and 2.5 D and 26% had SIA less than 1.5 D at the end of 3 months. Conclusion: The SIA in most of the SICS done by junior residents was above 1.5 D. It depended mainly on the incision length, its distance from the limbus, and the suturing technique.

In silico annotation of a hypothetical protein from Listeria monocytogenes EGD-e unfolds a toxin protein of the type II secretion system

The gram-positive bacterium Listeria monocytogenes is an important foodborne intracellular pathogen that is widespread in the environment. The functions of hypothetical proteins (HP) from various pathogenic bacteria have been successfully annotated using a variety of bioinformatics strategies. In this study, a HP Imo0888 (NP_464414.1) from the Listeria monocytogenes EGD-e strain was annotated using several bioinformatics tools. Various techniques, including CELLO, PSORTb, and SOSUIGramN, identified the candidate protein as cytoplasmic. Domain and motif analysis revealed that the target protein is a PemK/MazFlike toxin protein of the type II toxin-antitoxin system (TAS) which was consistent with BLASTp analysis. Through secondary structure analysis, we found the random coil to be the most frequent. The Alpha Fold 2 Protein Structure Prediction Database was used to determine the three-dimensional (3D) structure of the HP using the template structure of a type II TAS PemK/MazF family toxin protein (DB ID_AFDB: A0A4B9HQB9) with 99.1% sequence identity. Various quality evaluation tools, such as PROCHECK, ERRAT, Verify 3D, and QMEAN were used to validate the 3D structure. Following the YASARA energy minimization method, the target protein's 3D structure became more stable. The active site of the developed 3D structure was determined by the CASTp server. Most pathogens that harbor TAS create a crucial risk to human health. Our aim to annotate the HP Imo088 found in Listeria could offer a chance to understand bacterial pathogenicity and identify a number of potential targets for drug development.

Application of ABC-VED analysis for inventory control in drug store of a tertiary care hospital of North Maharashtra

Introduction: The hospital’s pharmacy is one of the most heavily used therapeu?c services and one of the few places where a significant amount of money is spent on recurrent purchases. This underlines the need of strategically planning, crea?ng, and arranging the pharmacy to ensure effec?ve clinical and administra?ve services. Materials and Methods:Inventory control techniques like ABC, VED and ABC-VED matrix analysis were used to evaluate the annual drug expenditure at drug store of Government Medical College & Hospital Jalgaon for the financial year 2019-20. Results:Total number of drugs in inventory in Government Medical College & Hospital Jalgaon in the year 2019-20 were 334 and the annual drug expenditure was 54040462/-. Category A comprised of 49 drugs (14.7%) for which annual drug expenditure was 37286500/- i.e. 69%. 87 drugs (26%) accoun?ng to 11324859/- (20.96%) were classified as category B drugs. Category C drugs included 198 drugs comprising 59.3% of total inventory and consumed 5429103/- i.e. 10.05% of total annual drug expenditure. 39 drugs (11.7%) were classified into vital/V category which accounted for 15257089/- i.e. 28.23% of annual drug expenditure, while essen?al/E category included 127 (38%) drugs for which 30161684/- (55.81%) was incurred for their procurement. 168 (50.3%) drugs accoun?ng to 8621689/- (15.95% of total annual drug expenditure). Conclusion:The applica?on of inventory control strategies such as ABC, VED, and the ABC-VED Matrix will help in significant improvements in pa?ent care.

Disseminated tuberculosis presenting as cardiac tamponade—Uncommon presentation in common disease

Tuberculosis is the most common infection in India, and its incidence accounts for approximately one-fifth of the global burden. Cardiac tamponade resulting from the liver abscess with subdiaphragmatic rupture communicating with pericardial cavity presenting as disseminated tuberculosis is uncommon. Here, we reported a case of a 63-year-old man who presented with the shortness of breath for 3 days with orthopnea. Imaging studies reveal pericardial effusion, left liver lobe loculated lesion, and enlarged right supraclavicular lymph node. Further image-guided pericardiocentesis, left liver lobe aspiration cytology, and right supraclavicular lymph node cytology reveal granulomatous inflammation with positive acid-fast bacillus in the liver aspirate. The patient was managed in the emergency room symptomatically initially and was then successfully treated with antituberculous treatment.

Brivaracetam Intravenous Formulation in Epilepsy Management in India : A Position Statement

Brivaracetam (BRV), a propyl analog of levetiracetam, has been shown to be safe and effective in Indian patients with uncontrolled focal epilepsy. A series of advisory board meetings involving pediatricians, neurologists, and physicians were held across India to evaluate the role of IV BRV in India and formulate a position statement. The panelists opined that the potential role of BRV in the acute management of increased seizure activity, especially status epilepticus, should be explored in the Indian context. Further, there is a dearth of Indian studies on the use of BRV in epilepsy patients aged below 16 years. IV BRV holds great potential to be the therapy of choice in epilepsy management owing to the fast mode of action and lesser risk of adverse effects.

Surgical Site Infection Prophylaxis and Wound Management in Spine Surgery

Surgical site infection (SSI) is a potentially devastating complication of spinal surgery that increases patient morbidity and healthcare costs. SSIs have complex and multifactorial etiologies; therefore, there are numerous opportunities for prevention and risk mitigation. The aim of this narrative review was to describe the incidence, risk factors, and outcomes of SSIs in spine surgery with an emphasis on postoperative wound care. We list and describe the preoperative, intraoperative, and postoperative evidence-based interventions that can be applied to potentially prevent SSI after spinal surgery.

Prevalence of primary bacterial co-infections among patients with COVID-19 in Brunei Darussalam

@#Objective: Bacterial co-infections in cases of coronavirus disease 2019 (COVID-19) can lead to less favourable outcomes. The aim of this study was to determine the prevalence of primary bacterial co-infections among patients with COVID-19 in Brunei Darussalam. Methods: Seventy-one of 180 patients admitted to the National Isolation Centre between 9 March 2020 and 4 February 2021 were screened for primary bacterial co-infection (infection occurring <48 h from admission). We compared patients with a primary bacterial co-infection to those without. Results: Of the 71 screened patients, 8 (11.2%) had a primary bacterial co-infection (sputum 37.5% [6/16], blood 2.8% [1/36], urine 1.7% [1/60]), for a period prevalence rate of 4.4% (respiratory tract infection 3.3% [6/180], bloodstream 0.6% [1/180], urine 0.6% [1/180]) among all COVID-19 patients. Older age, presence of comorbidity, symptoms at admission (fever, dyspnoea, nausea/vomiting), abnormal chest X-ray (CXR) and more severe COVID-19 (P < 0.05) were associated with primary bacterial co-infection. Primary bacterial co-infection was also associated with development of secondary infection and death (all P < 0.05). Only one patient with primary bacterial co-infection died (methicillin-sensitive Staphylococcus aureus septicaemia and multiorgan failure). Conclusions: Our study showed that primary bacterial co-infection affected 4.4% of patients with COVID-19 in Brunei Darussalam. Older age, presence of comorbidity, symptoms and abnormal CXR at admission and more severe disease were associated with a primary bacterial co-infection. Lower respiratory tract infection was the most common co-infection.

Role of Fine Needle Aspiration Cytology in the Diagnosis of Parotid Gland Tumors: Analysis of 193 Cases

Abstract Introduction Parotid gland tumors include a wide variety of inflammatory and neoplastic diseases. The majority of these tumors are benign (80%), which usually require superficial parotidectomy, while the incidence of malignant tumors is lower (20%), requiring more radical surgery with or without neck dissection. The diagnosis cannot be established on the basis of clinical history and simple physical examination and requires complementary diagnostic methods. Fine needle aspiration cytology (FNAC) guided by ultrasound is a widely used diagnostic tool to evaluate parotid swellings. Objective To determine the sensitivity, specificity, positive and negative predictive values and diagnostic accuracy of FNAC in the diagnosis of parotid gland tumors. Methods A retrospective chart review of 193 patients who underwent preoperative FNAC and parotidectomy at the Aga Khan University Hospital, Karachi, Pakistan, from the period of January 2000 to December 2015 was performed. Results Out of 193 patients undergoing parotidectomy, 110 (57%) were males and 83 (43%) were females, the mean age being 48.21 and 43.76 years old, respectively. The mean duration of the symptoms was 41.33 months, and the most common symptom was preauricular swelling present in all patients, followed by pain, which was present in 29 patients (15%) and facial nerve weakness in 6 patients (3.1%). Fine needle aspiration cytology was performed preoperatively and the results were compared with the final histopathology, which showed sensitivity of 88.9%, specificity of 97.9%, positive predictive value of 93%, negative predictive value of 96.7% and diagnostic accuracy of 95.8%. Conclusion Our results suggest that FNAC is relatively an accurate method for preoperative diagnosis of parotid swelling and can prove to be a valuable tool for preoperative counseling of the nature of the disease and prognosis.

Evaluation of Relationship of the Methylene Tetrahydrofolate Reductase Enzyme Polymorphisms with Serum Methotrexate Concentration and Toxicity in Acute Lymphoblastic Leukemia Patients Treated with High Dose Methotrexate Infusion

Background: Methotrexate (MTX) blocks MethyleneTetrahydrofolate Reductase (MTHFR) Enzymethereby, interrupt folate metabolism, it is used in thetreatment of cancer and autoimmune disorders. Aimand Objectives: The present study aimed to evaluatethe relationship of the MTHFR polymorphisms withserum MTX concentration and its toxicity in AcuteLymphoblastic Leukemia (ALL) patients treated withhigh dose MTX infusion. Material and Methods: Levelof Serum MTX was measured, along with the detectionof MTHFR polymorphisms viz. C677T and A1298Cby Polymerase Chain Reaction (PCR) followed byDNA sequencing. The percentages of toxicitydeveloped in patients were calculated among the wildtype and carriers for both polymorphisms and werecompared between the groups. Results:The majority ofpatients 36 (72 %) were wild type for the C677Tpolymorphism and 32 (64 %) of patients were carriersfor the A1298C polymorphism [48% heterozygous(AC), and 16 % homozygous (CC)]. Among 50 ALLpatients studied, significant difference was noted in thegenotype and allele frequencies for C677Tpolymorphism, while only allele frequencies differedsignificantly for A1298C polymorphism. The serumMTX level at 48 hours after the start of High DoseMTX (HDMTX) infusion of the C677T variant (CT)was slightly high in all four cycles however, in the firstcycle, there was a significant increase in the level ofMTX. There was no significant difference in the serumMTX level found in all four cycles between patientswild type and carriers for A1298C polymorphism. ForA1298C polymorphism, the mean SGPT level incarriers was significantly high as compared to wildtype. Conclusion: The present study concludes thatpatients with C667T variant had elevated serum MTXconcentration at 48 hours after the start of HDMTXinfusion.

mRNA Expression of Podocyte Associated Proteins in Peripheral Blood Mononuclear Cells of Type 2 Diabetes Mellitus Patients with and without Nephropathy.

Background: Diabetic nephropathy is the leading causeof End-Stage Renal Disease (ESRD) emerging indeveloped as well as developing countries, with thecomplicated pathogenesis. The study of expression ofthe genes related to kidney cells e.g. podocytes has beenshown to be associated with the condition, helping in theelucidation of pathogenesis of the disease. Previouslythe gene expression associated was studied in urinesamples. Material and Methods: In the present study, itwas attempted to analyze the mRNA expression ofpodocyte related genes viz. podocalyxin, podocin andsynaptopodin in Peripheral Blood Mononuclear Cells(PBMCs) in patients with diabetes with and withoutnephropathy in comparison with healthy controls byreverse transcriptase Polymerase Chain Reaction(PCR), followed by semi-quantitative PCR. Results:The expression of Synaptopodin (SYNPO) wasincreased in diabetics than the controls, while nosignificant difference was found for Podocalixyn(PODXL) and Podocin (NPHS2). The expression ofPODXL and NPHS2 was significantly up-regulated;SYNPO was unaltered in microalbuminuric patientsthan healthy controls. PODXL and SYNPO wereincreased significantly in nephropathy subjects thancontrols, with no significant change in NPHS2. Theexpression of only PODXL was found to be upregulated in microalbuminuric patients as compared toT2DM patients without nephropathy. PODXL, SYNPOwere significantly up-regulated and NPHS2 wassignificantly down-regulated in nephropathy subjects ascompared to T2DM patients without nephropathy. Asignificant down-regulation was found for NPHS2expression in nephropathy patients than microalbuminuric patients of T2DM with nephropathy.Conclusion: The detection of gene expression of theseproteins can be used as an early marker for the detectionof development of nephropathy in T2DM patients andpreventive measures can be taken to prolong the onsetof nephropathy in these patients, increasing the lifeexpectancy.

Factors Associated with Drain Output in Patients Undergoing to Parotidectomy

Abstract Introduction Tumors of the parotid gland are heterogeneous. The purpose of the drain placement is to evacuate fluid that has a potential to accumulate in the dead space and cause infection after parotidectomy. Objectives To evaluate the factors associated with drain output among patients submitted to parotidectomy. Methods A retrospective cohort study was conducted in the Department of Otolaryngology/Head and Neck Surgery at the Aga Khan University Hospital, Karachi, from January 1994 to December 2014. Patients who underwent parotidectomy were included in the study. Linear regression analysis was used to determine the factors associated with drain output. Results A total of 193 patients were included in the study. The mean age of the patients was 46.3 years, and 57% of them were male. Length of surgery (β coefficient = 24.2; 95% confidence interval [95%CI]: 4.94-85.26), type of neck dissection (modified radical neck dissection: β = 93.9; 95% CI: 30.47-157.38; selective neck dissection: β = 79.9; 95%CI: 29.04-126.85), and type of parotidectomy (total β = 45.1; 95%CI: 4.94-85.26) were factors that significantly influenced drain output in patients submitted to parotidectomy with or without neck dissection. Conclusion Neck dissection, total parotidectomy and length of surgery were predictors of postoperative neck drainage in our cohort. These factors can help predict postoperative neck drain output and help in patient counselling.

Quality of life assessment after successful percutaneous transmitral commissurotomy and ascertain its relationship with gender / Evaluación de la calidad de vida tras comisurotomía mitral percutánea exitosa y determinación de su relación con el sexo

Abstract Background: percutaneous transmitral commissurotomy has become an ideal treatment option for mitral stenosis due to its less adverse events and more favorable outcomes. Patients improve symptomatically after percutaneous transmitral commissurotomy but we have minimal available data about the quality of life after percutaneous transmitral commissurotomy. Objective: to assess the quality of life after percutaneous transmitral commissurotomy through WHOQol scoring covering different aspects of life, to determine its correlation with a net gain in mitral valve area (MVA) and to ascertain its association with gender. Methods: it was a prospective cohort study carried out for a period of 15 months. A total of 100 patients with mitral stenosis who had successful percutaneous transmitral commissurotomy done were enrolled in the study. Among the total included, 4 patients were lost to follow up and data were collected from 96 patients. Quality of life was assessed before the procedure, at 1 month and 3 months follow up after percutaneous transmitral commissurotomy using WHOQol scoring questionnaire. Results: among 96 patients, 64 (67%) were females and 32 (33%) were males. WHOQol scoring improved significantly after percutaneous transmitral commissurotomy from 32.8±8.9 to 54.6±11.2 and 62.8± 9.7, after one month and 3 months respectively. There was a significant association between net gain of MVA and WHOQol scoring with an R value of 0.46 and p value of 0.03. There was no difference in group comparison of all the six domains between male and female patients. Conclusion: successful percutaneous transmitral commissurotomy improves the quality of life in mitral stenosis patients regardless of their gender and has a positive correlation with a net gain in mitral valve area.

Resumen Antecedentes: La comisurotomía mitral percutánea se ha convertido en una opción terapéutica ideal para la estenosis mitral, debido a efectos menos adversos y a resultados más favorables. Los pacientes mejoran sintomáticamente tras la realización de esta técnica, aunque se dispone de escasos datos acerca de la calidad de vida tras su puesta en práctica. Objetivo: Evaluar la calidad de vida tras la comisurotomía mitral percutánea mediante la puntuación WHOQol, que cubre diferentes aspectos de la vida, para determinar su correlación con la ganancia neta del área valvular mitral (AVM), y determinar su asociación con el sexo. Métodos: Estudio prospectivo de cohorte durante un periodo de 15 meses, en el que se incluyeron 100 pacientes con estenosis mitral a quienes se les practicó con éxito comisurotomía mitral percutánea. De entre el total incluido, se perdieron 4 pacientes durante el estudio, por lo que se recolectaron datos de los 96 pacientes restantes. La calidad de vida se evaluó antes del procedimiento, y transcurridos un mes y tres meses de seguimiento, utilizando el cuestionario de puntuación WHOQol. Resultados: De los 96 pacientes, 64 (67%) eran mujeres y 32 (33%) varones. La puntuación WHOQol mejoró considerablemente tras la realización de la comisurotomía mitral percutánea, con valores de 32,8±8,9 a 54,6±11,2 y 62,8± 9,7, transcurridos uno y 3 meses, respectivamente. Se produjo una asociación significativa entre la ganancia neta de AVM y la puntuación WHOQol, con un valor R de 0,46 y un valor p de 0,03. No se produjo diferencia alguna en cuanto a la comparación grupal de los seis dominios entre varones y mujeres. Conclusión: La comisurotomía mitral percutánea exitosa mejora la calidad de vida de los pacientes de estenosis mitral, independientemente del sexo, y tiene una correlación positiva con la ganancia neta del área valvular mitral.

A rare case of colonic perforation presenting as Fournier’s gangrene

A 48-year-old obese gentleman with mild pain over abdomen for 10 days followed by pain and swelling in the right side of scrotum with skin discolouration for 2 days. Clinically necrotic patch with pus discharge was noted on the right side of scrotum. Extensive debridement over scrotum was done following which inflamed omentum and fecal contents were noticed from the inguinal canal. Patient underwent laparotomy and an ascending colonic perforation was found. A loop colostomy with partial omentectomy and inguinal hernia repair along with serial debridement of scrotal wound was done. Although uncommon, gastrointestinal perforations should be considered as a potential etiology in Fournier’s gangrene.

Distribution of Angiotensin Converting Enzyme I/D Polymorphism in Diabetic and Diabetic Nephropathy Patients at a Tertiary Care Hospital in Maharashtra.

Background: Diabetes Mellitus (DM) is one of theleading non-communicable disorders, leading tovarious complications viz. cardiovascular diseases,retinopathy, nephropathy, neuropathy and peripheralvascular disorders. Diabetic Nephropathy (DN)patients further develop into End Stage Renal Disease(ESRD) and they have to undergo the repeated bloodtransfusions, increasing the social and economicburden. The number of risk factors are known forcausation of diabetic nephropathy including theenvironmental, biochemical as well as genetic factors.The association of nephropathy with various genes hasbeen proved. Aim and Objectives: In the present studywe attempted to check the association ofInsertion/Deletion (I/D) polymorphism of AngiotensinConverting Enzyme (ACE) in diabetic patients withand without nephropathy and also with thebiochemical markers. Material and Methods: Eachgroup consisted of 110 individuals viz. diabetics withand without nephropathy and age and gender matchedhealthy controls. Results: The determination of I/Dpolymorphism by polymerase chain reaction revealedthe significant increased 'D' allele frequencies inpatients of diabetes with and without nephropathy thanthe controls, while no significant difference was notedin genotype frequencies. The odds ratios for thispolymorphism were calculated to be 1.84 and 2.41 forDM and DN respectively in comparison with thehealthy controls. The regression analysis indicated I/Dpolymorphism is associated positively with all thelipid parameters, except High Density LipoproteinCholesterol (HDL-C) which was negatively associatedwith the polymorphism. The levels of lipid parameterswere also significantly increased in patients of diabeteswith and without nephropathy carriers for 'D' allelethan the patients having 'I' allele, while the level ofHDL-C was significantly decreased. Conclusion: Theconclusion can be made from these results that, thepresence of I/D polymorphism of ACE may increasethe risk of development of nephropathy in generalpopulation, with the role of 'D' allele in its causation,along with its effect on the biochemical markers.

Clinical and sonographic estimation of fetal weight and correlation with the birth weight: a research article

Background: Accurate estimation of fetal weight is of paramount importance in the management of labour and childbirth. In developing countries including India, estimation of fetal weight by clinical method is important as ultrasound is not available in all health care settings. In view of this, the present study was conducted to estimate the fetal weight assessed by clinical and ultrasound method and correlating with the birth weight.Methods: A cross-sectional study was conducted to estimate fetal weight clinically by using Johnson’s formula and sonographically based on Hadlock’s formula in the Department of Obstetrics and Gynecology in collaboration with Department of Radiodiagnosis, Regional Institute of Medical Sciences, Imphal from October 2016 to March 2018. The study consisted of 525 pregnant women between 37 to 40 weeks of gestation in whom delivery was anticipated within one week of fetal weight estimation by clinical and ultrasound method and correlating it with the baby’s birth weight measured immediately after delivery. Analysis was done using Chi-square and Student’s t-test and p-value of <0.05 was taken as significant.Results: Both methods showed positive correlation with birth weight but clinical method (r=0.925) had stronger correlation compared with ultrasound method (r=0.508).Conclusions: Fetal weight estimation using Johnson’s formula had stronger correlation with the birth weight than ultrasound method and hence, useful for developing countries and all health care workers may be sensitized about the method.

The Efficacy of Tranexamic Acid in Cardiac Surgery Requiring Cardio-Pulmonary Bypass (CPB) to Reduce Post-Operative Blood Loss and Requirement of Allogenic Blood Transfusion

Introduction: Cardiac surgery, owing to its invasiveness,need of anticoagulation, exposure to extracorporeal circulation(CPB) and relatively longer duration, is known to be associatedwith an increased risk of perioperative blood loss and allogeneicblood transfusions. Excessive bleeding requiring allogenicblood and blood components transfusion after cardiopulmonarybypass (CPB) is a common complication of cardiac surgeryimparting detrimental health and economic consequences.Many techniques like preoperative autologous blood collection(PAC), Acute normovolumic hemodilution (ANH), use ofminiaturized CPB circuit and use of ultrafiltration duringconduct of cardiopulmonary bypass (CPB) have been appliedin the past to conserve the blood during perioperative periodin cardiac surgery. Current study aimed to observe the efficacyof Tranexamic acid used during intraoperative period onpost-operative blood loss and requirement of allogenic bloodand blood products transfusion in cardiac surgical patientsrequiring cardiopulmonary bypass (CPB).Material and methods: 120 adult patients undergoingcardiac surgery requiring elective cardiopulmonary bypass(CPB) were categorized into 2 groups. Study (“TXA”) groupwas subjected to administration of tranexamic acid (20 mg/kg in divided doses). The 1st dose (10 mg/kg) was givenbefore initiation of CPB, 2nd dose (5 mg/kg) was given duringrewarming on CPB and 3rd dose (5 mg/kg) was given afterweaning off CPB along with protamine. The control (“NS”)group patients received normal saline as a placebo. Statisticalanalysis was done using “z test”.Results: “TXA” group had significantly lower post-operativebleeding and lesser requirement of allogenic blood and bloodproducts transfusion. The mean post-operative blood lossin “TXA” group was 427.42+/- 225.18 ml vs. 728.67+/-301.33ml in “NS” group. The mean PCV units transfused postoperatively in 72 hours in “TXA” group was 0.20+/-0.44 unitsvs. 0.67+/-0.60 in “NS” group. Patients in “TXA” group didnot require any FFP or platelets unit in contrast to “NS” groupwhere few patients required these products.Conclusion: The use of Tranexamic acid during intraoperative period in patient undergoing cardiac surgeryrequiring cardiopulmonary bypass circuit significantly reducesthe post-operative bleeding and requirement of allogenicblood and blood products transfusion.

Psychological impact of cancer on patients in a tertiary care centre: a prospective study

Background: Diagnosis of cancer, although physical in nature, has far reaching emotional impact on the person. The study aimed to analyse the psychological impact of cancer on patients with a focus on levels of distress and psychiatric comorbidity.Methods: It was a prospective study conducted on 169 consenting individuals in the department of radiation oncology, SKIMS, Jammu and Kashmir, India, in collaboration with the department of psychiatry, SKIMS medical college, Jammu and Kashmir, India, from November 2013 to January 2015. The NCCN distress thermometer was used to observe the temporal variations in the levels of distress over a period of time.Results: Anxiety disorders (panic disorder, generalized anxiety disorder and post-traumatic stress disorder) were the most common psychiatric disorders diagnosed constituting 59%, followed by depression in 29%. About 12% patients were not diagnosed with any psychiatric ailment. One female patient with anxiety disorder developed acute psychosis. Counselling and psychotherapy provided improvement in 45% patients with cancer. In all, 86.4% required medication during the course of treatment and majority had improvement with it. A mean distress score of 7.73 was seen before, 8.29 during and 7.66 after treatment.Conclusions: Cancer bore a significant impact on the psychological bearing of patients, ranging from anxiety disorder, post-traumatic stress disorder, depression to psychosis. Hence there is a need for monitoring psychological symptoms in cancer patients and development of appropriate psycho-oncology services.

Study of highly sensitive C-reactive protein in type 2 diabetes mellitus and prediction of cardiovascular risk with glycemic status

Inflammation plays a vital role in accentuating the formation of atherosclerotic plaque in diabetes mellitus. So, the measurements of inflammatory markers provide a method of assessing cardiovascular risk. Among the inflammatory markers, highly sensitive C-reactive protein (hs-CRP) is used to detect the low-level inflammation when it is within the normal range. Also, hs-CRP measurement may be useful for assessment of the risk of complication in diabetes patients. So, the present study is conducted to measure plasma hs-CRP level in T2DM and to determine adequate glycaemic control reduces hs-CRP level. The objectives of this study were to correlate HbA1c and hs-CRP in T2DM and predict cardiovascular risk with glycaemic status.Methods: Authors took 50 diabetic patients. The investigation includes FBS, PPBS, hs-CRP and HbA1c. hs-CRP is measured by immunoturbidimetry method. The reports were collected and compared with normal reference range.Results: The correlation between hs-CRP levels and HbA1c level after six months show a significant relationship where mean HbA1c values on day 1 and after 6 months were 8.088±1.219 and 7.518±0.693 respectively. The hs-CRP values were 2.508±1.050 on day 1 and 2.15±0.927 after 6 months proving that better glycaemic controls decrease hs-CRP thereby decreasing cardiovascular risk.Conclusions: hs-CRP values are directly related to HbA1c and better glycaemic control reduces risk of CVD.