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Purpose: The objective of this survey?based study was to examine the effects of personal protective measures taken at the level of instrument and surgeon during the pandemic on the optics in ophthalmology. Methods: The study involved an online questionnaire of 24 questions which was distributed to ophthalmologists practicing in several hospitals, including residents and fellows undergoing training in ophthalmology in India. The responses were collected through an online data collection tool (Google forms). The participants could choose from multiple options provided to them in each question. Results: A total of 285 participants out of 296 had used modified methods for examining and performing surgical procedures during the pandemic, while 78.7% (265) of the participants acknowledged having encountered difficulty in interpreting the ocular findings of patients while examining in personal protective equipment. Moreover, 58.7% (198) of our study respondents also reported that there was significant worsening of the quality of ophthalmological examination with pandemic?appropriate measures and 84.8% (286) of our study participants also felt that these measures have significantly added to the time of examination, hence increasing the risk of exposure to both patient and doctor. Conclusion: The workplace study has highlighted the crucial aspects of optics in ophthalmology during the pandemic. The protective measures taken during the pandemic have significantly worsened the quality of ophthalmological examination and increased the time taken to perform outpatient department?based and surgical procedures in ophthalmology
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A case of extensive atherosclerosis in an 88-year-old, chronic heavy smoker, associated with mobile thrombus in the left carotid bulb is presented. This patient also suffered from chronic obstructive pulmonary disease (COPD) and hypertension. He was fully worked up and confirmed as a case of the mobile thrombus attached to the plaque in the left carotid bulb by echocardiography and carotid Doppler. Thrombolysis of a large, mobile clot poses a theoretical risk of stroke worsening from incomplete fibrinolysis. He was prescribed anticoagulants and has been doing fine till the last follow-up. The importance of preventing premature atherosclerosis in the next generations is also discussed. We report this case to create awareness about this preventable malady and treatment options.
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Objectives: To study the efficacy and adverse effects of opioids in management of pain in children. Methods: A descriptive study was conducted in children aged below 15 years with moderate to severe pain, and response to opioids and adverse effects were assessed at 24, 48 and 72 hours after administration. Results: 100 children (68% males) with median (IQR) age of 6.5 (3.5,10) years were studied. 81% (n=81) children with moderate pain and 78.9% (n=15) with severe pain responded to opioids in 72 hours. Among children with severe pain of non-malignant origin, 80% (n=8) responded in 48 hours compared to 11.1% (n=1) with malignancy and this difference was statistically significant at 24 hours (P=0.005). Of children with severe pain 73.7% (n=14) developed adverse reactions compared to 30.9% (n=25) with moderate pain. Conclusions: Children with moderatesevere pain, either of malignant or non-malignant origin could be managed effectively with opioids without severe adverse effects.
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Background: Hepatic involvement is not an uncommon in dengue viral infection, which presents with elevation in serum aminotransferases due to reactive hepatitis. The study is aimed to know the pattern of changes in hepatic enzyme levels in dengue infection in pediatric patients and to assess it with clinical presentation of dengue in particularly patients without and with shock.Methods: Pediatric patients with serologically confirmed Dengue viral infection were enrolled in the study and divided clinically into a shock group and a non-shock group. SGPT and SGOT levels were measured from day one of fever onset till 7 days and within 3 days after shock in the shock group. Student t-test was used to analyze the statistical data.Results: 100 patients with a mean age of 8'2.6 years were included in the study. The incidence of abnormal SGOT and SGPT levels were 96.9% and 51.1% in the shock group, and 92.2% and 45% in the non-shock group respectively. 30% and 17.9% of the patients in shock group and only 9.9% and 4.2% in non-shock group had the respective SGOT and SGPT levels > 200 U/L. Patients in shock group had statistically higher levels of Serum aminotransferase compared to the non-shock group. SGOT tended to increase starting from one day before shock and continued to increase within a few days whereas SGPT was less likely to be affected.Conclusions: Pediatric patients with Dengue infection have raised Aminotransferases in particular SGOT, which is higher than SGPT level. Aminotransferase levels in shock patients are significantly high and increases up to 3 days.
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Background: The aim was to study the antibiotic resistance in children with urinary tract infection and to observe any difference between antibiotic resistance rates.Methods: It was a prospective study carried out in SKIMS Medical College Hospital, Srinagar over a period of two years from January 2017 to January 2019. The study included 210 children between 1 year and 15 years who had presented with complaints of urinary tract infection and whose urine cultures were positive for the growth of an organism. These children were analyzed in order to find the frequency of organisms grown on culture, sensitivity of organisms isolated on culture and the rates of developed resistance to the antibiotics.Results: A total of 210 patients aged were included in the study, encompassing 66 (31.4) males and 144 (68.6%) females. Out of 144 female children 108 were under 6years of age while as out of 66 male children 48 were under 6years of age. As per the growth on urine culture,' the commonest organism that grew on culture were Escherichia coli (E. coli) was observed in 156 (74.3%), enterococcus in 18 (8.57%), Proteus mirabilis in 11 (5.2%), Acinetobacter spp. in 7 (3.3%), Pseudomonas spp. 5 (2.4%), Staphylococcus aureus in 4 (1.9%), Morganella spp. in 3 (1.4%) patients. Authors found imipenem, aminoglycosides and nitrofurantoin as the most effective antibiotics for urinary tract infections in pediatric age group.Conclusions: From this study, they concluded that parenteral antibiotics to be started empirically for the treatment of UTIs in all pediatric age groups are' aminoglycosides. In contrast for outpatient management of urinary tract infections, our results suggest that nitrofurantoin should be used for children aged beyond 1 year of age due to the low rate of resistance to nitrofurantoin in patients aged over 1 year.
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Background: Functional disorders of the pelvic ?oor are a common clinical problem. Diagnosis and treatment of these disorders, which frequently manifest with nonspeci?c symptoms such as constipation or incontinence, remain dif?cult. MR Defecography has emerged over the last decade as a modality which additionally images the pelvic floor function in real time besides combining the advantages of previously used modalities and that of magnetic resonance i.e. multiplanar imaging, good temporal resolution and lack of radiation exposure. Dynamic MRI defecography is a relatively new imaging protocol which can be extremely useful in identification of anatomic and functional pelvic floor dysfunction such as organ prolapse, anismus and fecal incontinence. Excellent demonstration of the perirectal soft tissues allows assessment of spastic pelvic ?oor syndrome and descending perineum syndrome and visualization of enteroceles. The aim of the study was to assess causes of pelvic floor dysfunction.Methods: Authors evaluated 25 patients with cine Magnetic Resonance Defecography at our center between December 2018 and 15th May 2019. MR Defecography was done with help of 3 Tesla Somatom Seimens MRI. Ultrasound jelly was instilled into the rectum of patient via a short flexible tube while the patient lies in the lateral decubitus position on the scanner table before being moved into the gantry and was asked to defecate when instructed. Scanning was done in four phases-resting, straining, squeezing and defecation as per the standard protocol while patient lied supine.Results: Most common complaint encountered was that of constipation. Patients in age group 20-70 years were studied. Maximum patient were of the age group 40-50 years. Most common finding was organ prolapse in total 9 patients with anterior rectocele in 6 patients followed by rectal prolapse.Conclusions: Magnetic resonance defecography is an excellent modality for assessment of pelvic floor disorders. It has very good temporal resolution and high soft tissue contrast, also allows visualization of the pelvic floor function in real-time without any radiation load. Imaging the defecation process in real-time leads to a definitive diagnosis in cases of dysfunctional defecation and a precise diagnostic and pre-operative assessment in cases of organ prolapse.
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Background: Many medical students are dealing with day to day stress in their lives and they need to be both physically and mentally active to counter and overcome their daily problems. In such scenario, a non-pharmacological adjunct could prove useful to counter all of it so that they can work more efficiently. Many universities do recommend the use of peppermints and chewing gums. This study is conducted to see if any of these items actually have an influence on cognitive and physical abilities.Methods: A non-randomized controlled trial was performed on the undergraduate medical students of N.K.P. Salve Institute of Medical Sciences and Research Centre belonging to the age group of 18-21 years. They were given normal flavoured gum, mint flavoured gum and peppermint. A series of cognitive and physiological tests in both stressful and stress free environments were performed.Results: Consumption of peppermint in a stressful environment showed increase in attention span of the subjects and it increased the intelligence Wechsler Adult Intelligence Scale-R (WAIS-R) in both stress free and stressful environments. As compared to normal gum, peppermint and peppermint gum proved to be more effective. There was no significant change observed in alertness, reaction time, arithmetic ability, short term memory and fatigue index in any of the subjects.Conclusions: Peppermint has caused increase in the attention span and intelligence of medical students in a stressful work scenario. Peppermint gum was found to be more beneficial than normal gum.
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Background: Acute appendicitis is one of the most common cause of acute abdomen surgery. Several scoring systems have been adopted by physicians to aid in the diagnosis and decrease the negative appendicectomy rate. Tzanakis scoring system is one such score. Objective of present study was the validation of this scoring system in our population and compare its accuracy with histopathological examination (HPE).Methods: A retrospective study was carried out at the Department of Surgery at Mohammad Afzal Beigh Memorial Hospital Anantnag India. Tzanakis score was calculated in 288 patients who underwent appendicectomy from September 2016-2018 and HPE results were analysed.Results: 276 patients were eligible for the study. The sensitivity and specificity of Tzanakis score in diagnosing appendicitis was 90.66% and 73.68% respectively. The overall diagnostic accuracy was 86.23% with positive predictive value of 97.89% and negative predictive value of 36.84%.Conclusions: Tzanakis scoring system is an accurate modality in establishing the diagnosis of acute appendicitis and preventing a negative laparotomy.
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Background: Children with cancer have a greatly enhanced risk of contracting hepatitis B infection due to immunosuppression secondary to chemotherapy and radiotherapy, frequent blood transfusions, bone and peripheral vein punctures, tissue damage and mucositis. During the past 3 decades, multimodality therapy for childhood leukemia has resulted in markedly improved survival. Inspite of screening and immuno prophylaxis, hepatitis B infection rates in children with leukemia are high. In view of this, we decided to study the prevalence of hepatitis B among children with leukemia in our institution, and the possible risk factors.Methods: This was a cross sectional study carried out at a tertiary pediatric care center in North Kerala among 104 children between 1 and 12 years of age on treatment for leukemia.Results: Among the 104 children, only 17 (16.3%) had received primary immunization against hepatitis B. Of the 87 children who had not received primary immunization, 44.8% (n=39) developed hepatitis B, compared to 11.8% (n=2) in the vaccinated group (p=0.01).Conclusions: This study highlights the importance of primary immunization against hepatitis B in children with leukemia, and the need for universal coverage.
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Background: Drug reaction with eosinophilia and systemic symptoms is an outcome of a complex interaction between specific drugs, certain herpesviruse types and the immune system of the affected individual and is characterized by an unpredictable course and recurrent flares even after withdrawal of the offending drug and administration of systemic steroids. Aims: To identify the predictors of disease severity in drug reaction with eosinophilia and systemic symptoms. Methods: After obtaining ethical clearance from the institutional ethics committee and a written informed consent from individual study participant, the first hundred patients who required inpatient care in Government Medical College, Kozhikode with drug reaction with eosinophilia and systemic symptoms from January 1st 2011 were included in this study aimed to identify the predictors of disease severity in drug reaction with eosinophilia and systemic symptoms. Results: Male-to-female ratio of the study group was 0.8:1. The presence of atypical cells in peripheral smear and advanced age were found to be predictors of disease severity in drug reaction with eosinophilia and systemic symptoms, whereas, sex, facial erythema and edema and absolute eosinophil count were found not to be predictors of the same. Limitations: The main limitation of this study was our inability to assess the role of human leukocyte antigen (HLA) association and herpes virus reactivation in disease severity in drug reaction with eosinophilia and systemic symptoms. This study was also not designed to evaluate the response to treatment given and the mortality caused by drug reaction with eosinophilia and systemic symptoms. Conclusions: Studies on the predictors of severity in drug reaction with eosinophilia and systemic symptoms in different population groups may enable us to identify the warning signs and help to formulate the standard therapeutic guidelines.
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Foreign body (FB) aspiration is a potentially life threatening event where prompt and precise action can turn tears into smiles. We report a case of an eight-year school going boy, with one-month old history of foreign body aspiration. The boy was treated as a case of respiratory tract infection. It was due to reappearance of symptoms and signs of chest infection supported by chest radiography that prompted for the CT-chest. It was followed by rigid bronchoscopy to confirm the therapeutic diagnosis of FB aspiration. This case report highlights the importance of detailed thoughtful history in pediatrics particularly to FB aspiration.
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The purpose of this study was to evaluate surface characteristics of Reciproc (R25) WaveOne (WO) &WaveOne Gold (WOG) files using SEM before and after use. Methods: fifteen primary files from each system were scanned for surface defects before instrumentation at 10x-1000x. Each file was planned to be used to instrument six root canals and then examined under SEM after preparing three and six canals at same magnifications. Data were scored and statistically analysed using CHI –SQ and Anova tests (p≤ 0.05). Results: Surface defects were detected in all study groups with higher values in WO & WOG group before use. Surface defects significantly increased in both WO and WOG groups after use as compared to R25. WO & WOG group showed significantly greater defects including metal strips, pitting, craters, micro-cracks and blunt edges (p≤ 0.05). Conclusions: Wave One Gold file has a different metallurgy due to its gold finish that does not enhance its resistance to surface defects during clinical use. Wave One and Wave One Gold showed significant increase in surface defects after six canal use which limits their usage in more than one teeth in single patient.
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Aim: Antibiotic loaded bone cement has been used extensively in orthopaedic surgery and in the treatment of osseous defects resulting from joint infection, osteomyelitis, osteitis. No endodontic investigation has used this type of material in the treatment of bony resorptive defects of the periapical lesions associated with failed endodontic therapy or periapical surgery. Therefore, this study was conducted with the use of gentamycin loaded bone cement, to assess healing ability of osseous defects in apical re-surgery cases after failed apical surgery. Methods: In all patients periapical lesions were surgically removed and gentamicin loaded bone cement was used as root end filling material and then carefully packed without pressure into the bony defect. Results: Long-term recall demonstrated clinical and radiographic healing and good tolerance of bone fill material by the periapical tissues. Conclusion: results from this study shows that gentamicin loaded bone cement is a biocompatible material and can be used effectively in apical resurgery cases for treating recalcitrant infectious osseous defects of periapical lesions associated with failed periapical surgery.
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Introduction: Management of infected wounds is notalways simple and easy. Vacuum-assisted closure (VAC) isa wound healing therapy that utilizes a dressing system thatcontinuously or intermittently applies a negative pressure tothe wound surface. Our aim was to assess the Feasibility andadvantages of simplified version of otherwise costly VAC, orsimple suction drainage in selected cases.Material and methods: This prospective study was conductedin the unit 2nd of department of surgery at SMHS hospital, anassociated hospital GMC Srinagar, over a period of 3 yearsfrom January 2014 to December 2016. During this period, 32patients were subjected to vacuum suction treatment and wereincluded in this study.Results: Wall suction (VAC) was used in 26 patients. MiniVac drain (USG guided) was used in 5 cases. In one patient ofscalp infection conventional large size suction drain was used.The time taken for the wounds to become healthy was 3 to7(average 3.5) days of VAC dressing or suction drainage. Noantibiotics were given during suction drainage in 21 patients.Need for grafting by split skin grafting method was felt in only2 patients. Mild discomfort (abnormal sensation) was reportedin 21 patients. Hospital stay for patients managed by suctiontherapy ranged from12 hours (breast abcess) to 16 days withan average of 7 days. The total cost incurred in the patientsundergoing VAC for a period of 15 days per patient was Rs.800 ($ 12).Conclusion: VAC seems to have revolutionary potential inthe management of the difficult to treat infected wounds asfar as its safety, speed and cost-effectiveness are considered.
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Background: The main objective of this study was to evaluate prescription patterns of antihypertensives in preeclampsia patients at a tertiary care hospital in Central India.Methods: The study belongs to retrospective observational type. he study was conducted by department of Pharmacology in association of department of Obstetrics & Gynaecology department at Nkp Salve Institute of Medical Sciences & Research Centre, Lata Mangeshkar Hospital, Nagpur. Permission from Institute Ethics Committee was taken for studying the prescribing patterns of drugs. The study was conducted for a period of 6 months. Inclusion and Exclusion criteria were added.Results: The maximum number patients seen in age groups 36-41 (28.6%). The main drug prescribed in our study was Labetalol followed by methyldopa. In our study most of the patients were of moderate and mild type corresponding to 48% and 32% respectively and only 20% of patients belong to severe cases. In our study highest number of patients was seen in second gravida i.e. 33.33%.Conclusions: Labetalol was the most common anti hypertensive prescribed in pre eclampsia patients. Rationale prescribing of drugs were done.
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Background:This study was conducted to find out the pattern of poisoning cases among the pediatric population in Srinagar and its Northwestern suburbs and compare it with what occurs elsewhere in India. Thereby we aimed to provide practical knowledge in dealing with these pediatric patients.Methods:The hospital records of children between the ages of 0-19 years admitted to the pediatric emergency ward of SKIMS Medical College Hospital Srinagar with poisoning from July 2016 to June 2018 were evaluated.Results:A total of 154 cases of poisoning were admitted in the study period, of which 89(57%) were males and 69(43%) were females. In the 0-12 year age group the poisonings were mostly in boys(68.26%) and were accidental whereas in the 13-19 year agegroup poisonings were mostly in girls(64%) and due to suicidal attempts. Organophoshorus poisoning was the most commonly ingested poison across all age groups(44.8%) followed by rodenticides(16.23%), kerosene(13.63%) and medications(11.68%). Interventions mostly commonly done were gastric lavage, induced vomiting. Mortaliy was seen in 2 cases over 2 years(1.29%). Conclusion:Knowledge on epidemiological and clinical features ofpoisoning in children according to age groups, establishing safety standards for sale and storage of harmful chemicals, and parental education can help to decrease the burden of childhood poisoning
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Introduction: Long term success of any composite resinrestorative materials mainly depends on their color stability.The aim of the investigation was to examine the color stabilityof three resin-based composite materials with a high contentof inorganic filling material (Spectrum, Filtrex Z350 andTetric N Ceram).Material and Methods: Changes in color of test sampleswere determined after complete immersion in test solutionsused primarily in Kashmiri population viz. Kashmiri tea,Saffron Kehwa and a turmeric solution. Color differenceswere measured by using a spectrophotometer and CIE L*a*b*color scale and the total amount of color difference wasrepresented as ∆E.Results: For all composite resins, Turmeric solution causedthe most severe cases of discoloration (∆E > 8.25). Kashmiritea and Saffron Kehwa caused invisible (∆E <1) or visible (∆E>1) discoloration. In some samples clinically unacceptable(∆E > 3.3) discoloration was noted.Conclusion: No significant difference was found amongthe composite resins or between color values of specimensimmersed in Kashmiri tea or Saffron kehwa. Immersingspecimens in turmeric solution caused greater color changein all types of composite resins tested. It is apparent from theresults that it is essential to improve the color stability of thecomposite resin materials used in esthetic zone
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Cone beam computed tomography (CBCT) is called as C-armcomputed tomography, cone beam volume CT, or flat panelCT. It is an imaging technique in the field of dentistry inwhich the X‑rays are divergent, leading to the formation ofcone shaped beam. The system of CBCT has been designedfor imaging primarily the hard tissues of the maxillofacialregion. It contributes to accurate and effective treatmentplanning for the patient. The increasing demand of thistechnology provides the dental clinician with an imagingmodality capable of providing a three‑dimensional viewof the maxillofacial skeleton with least distortion. CBCTprovides a unique imaging option for various treatment needsof a prosthodontist. It can prove to be beneficial in variousaspects of prosthodontic practice i.e. from imaging of thetemporomandibular joint for accurate movement simulation,to denture therapy. CBCT could play an important role inreduction of hectic routine for the clinician. Therefore, theaim of this article is to specify the applications of CBCT in thefield of prosthodontics along with the benefits and limitationsof CBCT.
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To assess calcium and phosphate loss from enamel using 37.5% hydrogen peroxide (HP) gel with additional application of light emitting diode (LED), Diode laser and Nano-Pulsed Cold laser (NPCL) light sources compared to that of 37.5% HP alone using atomic absorption spectrophotometer (AAS). Methods: Twenty teeth were sectioned to obtain mesiobuccal, distobuccal, mesiopalatal and distopalatal specimens. The specimens were randomly assigned to four equal groups. 37.5% HP of 1mm thickness was applied to the enamel surface of each specimen. Each group received three cycles of bleaching of 8 minute’s duration. Group II, III & IV received additional application of LED, Diode laser & cold laser light respectively. Results: Data was analyzed by means of descriptive statistics. Group III showed the maximum loss of ions while Group IV showed the least loss and the differences were statistically significant (P < .05). Conclusion: Teeth treated with 37.5% hydrogen peroxide with application of Nano-Pulsed Cold Laser (NPCL) light presented with significantly minimal calcium and phosphate loss
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Bleaching of vital teeth is a very common practice nowadays prompted by high esthetic demands of patients. But bleaching agents are known to cause some transient damage to enamel microstructure, so the need arises to determine the effect of bleaching agents on the mineral content of enamel. Aim: To evaluate mineral loss from enamel using in-office bleaching agent Hydrogen Peroxide and the effect of LED and Laser activated bleaching agent on mineral loss from enamel. Methods: Forty human premolar crowns were divided into buccal and lingual specimens and 80 blocks of 4x4x3mm each were obtained. Samples were randomly divided into four groups of twenty each depending upon the beaching treatment and activation method. Group I – Hydrogen Peroxide without additional activation, Group II – Hydrogen Peroxide with additional activation by Diode Laser, Group III – Hydrogen Peroxide with additional activation by LED Light and Group IV – Control group. Amount of calcium and Phosphate loss was calculated using atomic absorption spectrophotometry. Results: Results showed that bleaching with hydrogen peroxide leads to calcium and phosphate loss from enamel with additional activation resulting in higher amounts of mineral loss especially with Laser activation. Conclusion: Bleaching agents result in calcium and phosphate loss from enamel with significantly high loss of minerals due to additional activation by Laser and LED Light. Therefore bleaching procedures must be followed by remineralization treatments to prevent damage to enamel.