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Background CORONAVIRUS disease 2019 (COVID-19) is a viral infectious disease caused by the single-stranded, enveloped RNA virus, severe acute respiratory syndrome coronavirus-2 (SARS COV-2). Though Covid-19 is an acute viral infection predominantly affecting the respiratory system, it has short-term, long-term metabolism and endocrine complications. Being a global pandemic with a high rate of recovery, it is expected to have many long-term metabolic complications in a vast number of covid-19 survivors. We aimed to find out the post covid complications in patients discha Objective: rged from SARI ward AIIMS Bathinda, Punjab. Design: Settings: Prospective observational study OPD and telemedicine consultation of the patients admitted to the tertiary hospital Material and Methods: - A prospective study was done on 244 patients with COVID -19 RAT, and RTPCR Positive patients were done. Patients were followed up in OPD and by telemedicine for post covid complications. Main outcome measures: The main outcome measures were measured in terms of mortality as well as morbidity. Morbidity was evaluated in terms of the complications developing after covid or persistence of the complications developed during the covid. All the patients who were admitted Sample size: to our tertiary Centre were followed for post covid complications. Result: - Out of 244 patients that were analyzed, 22% died during the disease, and 78% survived. Out of the patient who survived 64.8% developed post covid complications. 35.8% complained of fatigue, 10.5% developed headache, 8.9% developed body aches, 3.2% had a persistent cough, 1.6% had a sore throat and 1.1% had gastrointestinal symptoms. Conclusion: - In this population-based study large no. of patients suffer from long-term residual effects afterward-CoV-2 infection such as fatigue, cough, headache, dyspnea, and decline in quality of the eye. With a large range majority of people infected all over the world, our findings emphasize the need for timely planning of resources and patient care. Multidisciplinary collaboration is essential to provide integrated outpatient care for the survival of acute COVID-19. Limitation: Small sample size
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Background@#and Purpose High-grade carotid artery stenosis may alter hemodynamics in the ipsilateral hemisphere, but consequences of this effect are poorly understood. Cortical thinning is associated with cognitive impairment in dementia, head trauma, demyelination, and stroke. We hypothesized that hemodynamic impairment, as represented by a relative time-to-peak (TTP) delay on MRI in the hemisphere ipsilateral to the stenosis, would be associated with relative cortical thinning in that hemisphere. @*Methods@#We used baseline MRI data from the NINDS-funded Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis–Hemodynamics (CREST-H) study. Dynamic contrast susceptibility MR perfusion-weighted images were post-processed with quantitative perfusion maps using deconvolution of tissue and arterial signals. The protocol derived a hemispheric TTP delay, calculated by subtraction of voxel values in the hemisphere ipsilateral minus those contralateral to the stenosis. @*Results@#Among 110 consecutive patients enrolled in CREST-H to date, 45 (41%) had TTP delay of at least 0.5 seconds and 9 (8.3%) subjects had TTP delay of at least 2.0 seconds, the maximum delay measured. For every 0.25-second increase in TTP delay above 0.5 seconds, there was a 0.006-mm (6 micron) increase in cortical thickness asymmetry. Across the range of hemodynamic impairment, TTP delay independently predicted relative cortical thinning on the side of stenosis, adjusting for age, sex, hypertension, hemisphere, smoking history, low-density lipoprotein cholesterol, and preexisting infarction (P=0.032). @*Conclusions@#Our findings suggest that hemodynamic impairment from high-grade asymptomatic carotid stenosis may structurally alter the cortex supplied by the stenotic carotid artery.
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Methods@#Amplitude and latency of TcMEPs were recorded bilaterally from the abductor pollicis brevis (APB) and abductor hallucis (AH) muscles in 38 adult American Society of Anesthesiologists I and II patients undergoing thoracolumbar spine surgery. Baseline recordings of TcMEPs in both groups were recorded under propofol infusion. Group X patients then received propofol and fentanyl (1 mcg/kg/hr), and group Y patients received ketofol and fentanyl (1 mcg/kg/hr). Bispectral index was maintained at 40–60 in both groups. Amplitude and latency were recorded at 30 minutes intervals for 2 hours. @*Results@#Propofol caused no significant changes in amplitude and latency in any muscle. In contrast, amplitude increased significantly at all time points in the bilateral APB muscles and 60, 90, and 120 minutes in the left AH muscle without changes in latency in response to ketofol. When the two groups were compared, ketofol induced significantly higher amplitudes at 60, 90, and 120 minutes in the (left) APB, at all time points in the (right) APB, and at 120 minutes in both AH muscles, compared with propofol. Blood pressures were lower and fluid and vasopressor requirements were higher in group X. Muscle power was similar between the two groups. @*Conclusions@#Ketofol facilitates TcMEP amplitudes without affecting latency. Use of ketofol resulted in a better and more stable hemodynamic profile than did use of propofol.
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BACKGROUND All medical graduates must know how to stabilize and manage critically ill patients. A 2-day intensive course, called the acute critical care course (ACCC), was conducted to train interns in technical and non-technical skills for managing a patient whose condition is deteriorating. This analysis aims to assess the feasibility and effectiveness of ACCC for interns. METHODS We developed and conducted the ACCC to train interns. It included lectures and skill stations. Twenty-four interns participated in the course. Immediate, post-course, quantitative and qualitative feedback was taken online. Qualitative information was also collected verbally and later by email. These data were analysed both quantitatively and qualitatively. Thematic analysis was used to identify, analyse and report the patterns of responses and behaviour. RESULTS The average score for the utility of the course was 4.7 and for the skill stations it was 4.6 on a scale of 5. The qualitative analysis of the feedback emphasized the need for the course before the clinical posting and more skill-based modules rather than lectures. The interactive style of teaching and training in communication using role-play was appreciated. Few suggestions to improve the course were provided. CONCLUSIONS Implementing the ACCC needed simulation, interactive discussions, role-play, modified Pendleton’s feedback, and reflective exercise that form the basis of a range of educational principles. The blended learning set of objectives of ACCC were the pillars for this successful internship training programme.
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Background. Effective patient–doctor communication is a key component of patient-centred care, which is one of the six pillars of quality healthcare delivery. Structured and effective communication skills training for healthcare providers is the need of hour in medical education. We assessed the efficacy of role play and simulation in developing communication skills. Methods. As a key component of an acute critical care course (ACCC), communication skills are taught using role play models and simulation. Live feedback is critical in learning during this course as per the principles of adult learning (andragogy). Quantitative and qualitative data were collected to assess the efficacy of ACCC. Results. The 19th ACCC was introduced to interns at the All India Institute of Medical Sciences, New Delhi in December 2018. The teaching methodology and objective-oriented structured training in ACCC were much appreciated for training in human factors with emphasis on communication. A positive response was obtained from the candidates 3 weeks after they completed the course to assess whether interns are able to make use of this training in their day-to-day clinical practice amounting to a reliable evidence level of Kirkpatrick's ‘return of investment’. Conclusion. The use of ‘role play’ to teach communication skills is effective and superior to lecture-based teaching. Further structured and interactive programmes in communication skills training will improve patient care, relatives’ satisfaction and the image of medical profession.
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The pregnancy is an immunocompromised state. Thus, autoimmune diseases may affect pregnancy and get worsen during pregnancy. Here authors discuss a rare autoimmune thrombophilia disorder, protein C and S deficiency which may cause recurrent pregnancy losses by affecting haemostatic mechanisms in the body. This patient with recurrent pregnancy loss when evaluated extensively was found to have combined inherited protein C and S deficiency. It was successfully managed with thromboprophylaxis therapy, which resulted in the delivery of healthy baby. Long term anticoagulant prophylaxis should be considered weighing the risk of bleeding to thrombotic recurrence in such cases. In conclusion, combined protein C and S deficiency and that too presenting as recurrent pregnancy loss is very rare. Thrombophilia screening should be considered in cases of recurrent pregnancy losses. Adequate and appropriate thromboprophylaxis is an important part of the management of pregnant women with inherited thrombophilia.
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Ovarian pregnancy is a rare event, with the incidence ranging from 1 in 2000 to 1 in 60 000 deliveries and accounts for 3% of all ectopic pregnancies. The first case of ovarian pregnancy was published by Saint Monnisey. Authors report a case of a 23-year-old patient with severe lower abdominal pain following five weeks of amenorrhea diagnosed as tubal ectopic pregnancy on ultrasonography. The patient was taken up for emergency laparoscopy and unexpected finding of ovarian pregnancy was established. Early diagnosis and prompt treatment go a long way to prevent serious outcomes and to ensure favourable future reproductive potential.
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Background: Elective gallbladder surgery is the most common abdominal surgical procedure. Antibiotic prophylaxis is a common conduct in open cholecystectomy, but there is ambiguity about the use of prophylactic antibiotics in laparoscopic cholecystectomy. Some surgeons suggest that the elimination of prophylactic antibiotics in patients undergoing elective laparoscopic cholecystectomy increase the incidence of postoperative infective complications but not to a statistically significant degree. The aim of this study was to evaluate the role of prophylactic antibiotics in laparoscopic cholecystectomy.Methods: A total of 100 patients were included and they were randomized in 2 groups of 50 each. Group A was given prophylactic intravenously (IV) antibiotic within 1 hour before surgery and group B was not given any antibiotics. Results were compared and data analyzed statistically using chi-square and t test. Complications in both the groups were compared.Results: Rate of surgical site infections were 6% (n=3) and 4% (n=2) in group A and B respectively; and the difference between them was not found statistically significant. All infections which occurred in present study were superficial surgical site infection. There was no evidence of deep-seated infections and none of the patients developed distant infection. There was no derangement in any of the biochemical parameter in this study.Conclusions: We were not able to demonstrate any significant benefit from addition of prophylactic antibiotics in elective laparoscopic cholecystectomy.
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Background: Diabetes mellitus refers to group of metabolic disorders characterized by hyperglycemia due to an absolute or relative deficit in insulin production or action. Diabetes mellitus produces pathological changes in most organs of the body including heart, blood vessels, kidneys, nerves and eyes. Cardiovascular autonomic neuropathy (CAN) is a severely debilitating yet underdiagnosed complication of diabetes. Diabetes-associated cardiovascular autonomic neuropathy damages autonomic nerve fibers that innervate the heart and blood vessels causing abnormalities in heart rate and vascular dynamics.Methods: Total 80 cases of diabetes mellitus were selected. Cardiac autonomic neuropathy in them was diagnosed by a series of tests recommended by Ewing et al, which include - Valsalva ratio, Deep Breath Test, Heart rate response to standing, Postural Hypotension, SHGT Increase in diastolic BP on sustained hand grip. They were divided into 2 groups A and B depending on presence or absence of cardiac autonomic neuropathy. ECG was done to calculate QTc and QTd.Results: In group A mean QTc was 0.344 sec and in group B in patients with mild CAN mean QTc was 0.432, moderate CAN mean QTc was 0.444, and in patients of severe CAN mean QTc was 0.481. p value was 0.001 that it is highly significant. Means more was degree of CAN more was prolongation of QT and similarly more the degree of CAN more was QTd.Conclusions: Diagnosis of cardiac autonomic neuropathy by battery of cardiac autonomic function tests is a comlex procedure. The prolongation of QTc interval and more specifically QTd interval on ECG is a marker in diagnosis of cardiac autonomic neuropathy which can be easily evaluated.
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Upregulation of antioxidant system provides protection against drought induced oxidative stress in plants. Proline, an important osmolyte, acts as ROS scavenger, membrane stabilizer and also as protectant of enzymes. In this study, we investigated the effect of proline pre-treatment on the inhibitory effects of water deficit stress in two contrasting wheat cultivars, i.e. PBW 644 (Drought tolerant) and PBW 621 (Drought sensitive). Seedling growth was adversely affected in both the cultivars grown under stress. Pre-treatment of seeds with 15 mM proline stimulated seedling growth of both wheat cultivars accompanied by increased activities of SOD, POX, APX and GR and the contents of glycine betaine, proline and total phenols in the tolerant cultivar. In PBW 621, CAT and APX enzymes were upregulated along with increased glycine betaine content. Proline pre-treatment enhanced the membrane stability of both wheat cultivars grown under stress, as revealed by the significantly reduced malondialdehyde content. The levels of endogenous H2O2 contents in proline treated stressed seedlings of PBW 644 were also markedly lower than those of the non-treated stressed seedlings. The results indicated that proline pre-treatment could improve drought tolerance by stimulating ROS detoxification pathways, especially in tolerant cultivars.
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Introduction: Airway management is an essential component in the first aid of medical emergencies in the combat medical care. Though Endotracheal tube (ETT) is considered ideal for airway management, supraglottic airway devices (SGA) are gaining popularity as an alternative. We studied the use of a novel SGA device (BASKA® mask) in hospital which can be extended to the combat situation. Methods: In this randomised, clinical study, we compared two airway devices (ETT and Baska® Mask) for ventilation in patients (n=100) undergoing laparoscopic surgery. We evaluated the mean airway seal pressure, ease of insertion, time taken for insertion and the complication rates with the use of airway devices. The data were analyzed using appropriate statistical tests. Results: We found that the mean airway seal pressures were comparable with the two devices. The first–time success rate for insertion was higher with the Baska® mask than with the ETT (94% vs 70%) respectively (p < 0.001). The overall device insertion success rates were comparable between the two devices (100% vs 96% respectively, p = 0.5412). Conclusion: Baska® mask is comparable on various parameters to the ETT and is easier to insert due to its flexible head. This is relevant for airway management during combat medical support in field situations.
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Background: Drug advertisements form one of the major sources for updating drug information by the medical professionals. It has been observed that Indian drug advertisements provide incomplete and poor quality of essential information. However, existing information on comparison of drug advertisements in Indian and foreign journals is limited. Hence, this study was planned to compare the drug advertisements published in Indian and foreign journals. Methods: A total of 200 drug advertisements, 100 each from Indian and foreign journals, were randomly selected excluding those of medical devices, surgical appliances, nutritional supplements and ayurvedic drugs. The drug advertisements from two sources were compared for drug groups, compliance to „Ethical criteria for medicinal drug promotion‟ of World Health Organization (WHO), retrievability of cited reference(s) and mention of any additional information. Results: Drug groups advertised frequently in the Indian journals were those used for chronic diseases whereas chemotherapeutic agents topped the list in foreign journals. Brand names were mentioned in 100% advertisements in both categories of journals whereas information on other ingredients known to cause problems was not mentioned in any of the studied advertisements. Overall, compliance to WHO guidelines by advertisements was 54.6% in Indian journals and 68.2% in foreign journals. The two categories of journals didn‟t differ significantly in retrievability of cited reference(s) and additional information except for information on drug storage which was significantly more mentioned in Indian journals. Conclusions: Drug advertisements in both Indian and foreign journals were incomplete for updating drug information by medical professionals
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Background: Cardiovascular diseases are commonly associated with depression. Calcium channel blockers (CCBs) form commonly used group of drugs for the treatment of a number of cardiovascular diseases. Nifedipine, a CCB, has been shown to possess antidepressant activity and potentiate antidepressant activity of imipramine and sertraline, however, literature on its interaction with newer antidepressant drugs such as fl uvoxamine, venlafaxine and tianeptine is limited. Hence, the present study was undertaken. Methods: The study was carried out in albino mice in two phases. In Phase I, antidepressant activity of nifedipine, fl uvoxamine, venlafaxine and tianeptine were confi rmed after their single dose administration using forced swim test (FST) and tail suspension test (TST) and their minimum antidepressant doses were determined. In Phase II, the effect of nifedipine on antidepressant activity of fl uvoxamine, venlafaxine and tianeptine was studied by orally administering sub-antidepressant doses of these drugs for 28 days. FST and TST were carried out on 1st, 14th and 28th day of the study and change in immobility period was observed. Results: In Phase I, all the studied drugs exhibited dose dependent antidepressant activity in both FST and TST. Minimal antidepressant dose of nifedipine, fl uvoxamine, venlafaxine and tianeptine was observed as 10, 25, 25 and 10 mg/kg respectively. In Phase II, combinations of sub-antidepressant dose of nifedipine (5 mg/kg) with sub-antidepressant doses of fl uvoxamine (12.5 mg/kg), venlafaxine (12.5 mg/kg) and tianeptine (5 mg/kg) exhibited enhanced antidepressant activity when compared to the control group and individual drug groups after same duration of treatment. Conclusions: Nifedipine, fluvoxamine, venlafaxine and tianeptine possess antidepressant activity and nifedipine exhibits synergistic antidepressant activity with fl uvoxamine, venlafaxine and tianeptine.
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Background: The present study was conducted to analyze the prescribing patterns and utilization of antihypertensive drugs at a tertiary care center in India. Methods: A cross-sectional analysis of prescriptions of patients of essential hypertension attending outpatient department of a tertiary care hospital during the period of December 2011 to March 2012 was done. Hypertensive patients with comorbidities were excluded from study. The data were analyzed to fi nd out demographic characteristics of patients, number of drugs prescribed per prescription, drugs, which are commonly prescribed, antihypertensive drugs used concurrently, percentage of drugs prescribed by generic name and over all drug utilization frequency. Results: During the study period, 465 prescriptions for hypertension were analyzed. This study revealed that most of the patients were on combination of antihypertensive drugs (67.97%) while 31.18% patients received mono therapy. Among mono therapy drugs, calcium channel blockers (CCB) (31.03%) were prescribed most. Utilization of other major drug classes as mono therapy in decreasing order is angiotensinconverting enzyme inhibitors (28.28%), diuretics (17.93%), beta-blockers (11.72%) and angiotensin receptor blockers (10.34%). Among those who were treated with drug combinations, 64.24% received 2-drug, 25.95% received 3-drug regimen and 8.54% received 4-drug regimen. In combination therapy, 2-drug combination consisting of a CCB and a diuretic was most commonly (24.14%) prescribed. Conclusions: This study represents the current prescribing patterns for antihypertensive drugs and provides the baseline data for similar studies in future, as patterns in prescribing antihypertensive drugs keep changing.
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Background: Paracetamol is used for symptomatic treatment of fever and pain with isoniazid and other anti-tubercular drugs in patients of tuberculosis. Literature has conflicting data regarding their interaction. Some studies show that isoniazid increases oxidative metabolism of paracetamol whereas some other suggest that isoniazid has an inhibitory effect. The present study was conducted to find out the possible interaction between paracetamol and isoniazid. Methods: The study was undertaken on Wistar strain of Albino rats. Group I and Group II animals were treated with paracetamol (500 mg/kg) and the combination of paracetamol (500 mg/kg) and isoniazid (30 mg/kg) respectively for 2 months. Blood samples were taken before and during the study for biochemical and histopathological studies of liver and renal functions and plasma paracetamol concentration was also evaluated. Results: Isoniazid decreased the plasma paracetamol concentration without affecting its analgesic activity. However, the hepatotoxic and nephrotoxic effects of paracetamol were found to be further aggravated by isoniazid co-administration. Conclusion: Isoniazid potentiates the hepatotoxic and nephrotoxic effects of paracetamol possibly due to hepatic enzyme induction by isoniazid.
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Evaluation of Nutritive contents of two plant species of Western Rajasthan i.e. Psoralea odorata Blatt and Halb and Glinus lotoides Linn were carried out. The selected plant species collected from local area of Bikaner region, root, shoot and fruit were separated and analysed for nutritive contents. Crude protein, crude fat, total ash, nitrogen free extract (NFE), organic matter, total carbohydrates, calcium and phosphorus were analysed.
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Extract of flavonoids from plant parts and callus tissues of Glinus lotoides (molluginaceae) and Psoralea odorata (fabaceae) were screened against microbes’ viz., Bacillus cerus, Escherchia coli, Salmonella typhimurium, Staphylococcus aureus and Candida albicans adopting disc diffusion method. Results were compared with the zone of inhibition produced by commercially available standard antibiotics. Maximum activity was observed in flavonoid of callus tissue as compared to plant parts of both plant species.
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Gypsophila pilulifera, Boiss & Heldr, Caryophyllaceae, is a perennial medicinal herb that grows in the southwestern region of Turkey. Except for only one report on the isolation of cytotoxic saponins from the underground parts of G. pilulifera, there are no published thorough phytochemical or bioactivity studies on this species. In the present study, the free-radical scavenging activity of extracts and fractions of the stems of G. pilulifera was evaluated, using a slightly modified and more precise version of the 2,2-diphenyl-1-picrylhydrazyl (DPPH) assay, reported here for the first time. The DPPH assay-guided HPLC-PDA-purification of the active solid-phase extraction fraction (50% methanol in water) of the methanolic extract exhibited verbascoside as the main free-radical scavenger present in this species. The structure of this active compound was resolved by spectroscopy, and the free-radical scavenging potential of verbascoside was determined.