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Background- Patients with psychiatric illnesses require support from family, peers, and care-givers to overcome the difficulties and manage their health. Caregivers are hence at a risk themselves to develop anxiety and depression, or related symptoms, due to the emotionally challenging and draining experience. Aim – To evaluate and assess anxiety and depression of caregivers to the patients admitted to the Psychiatry department of a tertiary care centre located in Rajasthan. Materials and Methods- Our assessment relied on data collection that followed cross-sectional observational analysis. We performed the study post approval of the ethical clearance by the respective committee at the university and an informed decision was consented to in written by 50 caregivers taking part in the study. These included caregivers to 25 patients with disorders due to substance use (Group A) and 25 patients with other psychiatric diagnosis (Group B). We also filled in socio-demographic details and performed scoring as administered by the HAM-D and HAM-A scales. ResultsGroup A comprised of more females (64%) than males in contrast to Group B participants. HAM-D score analysis showed that depression was present in Group A (52%) as compared to Group B participants (40%). HAM-A analysis of score showed anxiety in 34% of caregivers and was higher among Group A participants and among female caregivers. Conclusions- The results of the study can be used to plan for early interventions, to reduce stress among caregivers of patients with psychiatric illness
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Purpose: The objective of this study was to identify the association between fetal hemoglobin (HbF) concentration, blood transfusion, and retinopathy of prematurity (ROP) in preterm infants. Methods: This was an observational, prospective study. A total of 410 preterm infants born with <36 weeks gestational age and <2.0 kg birth weight in a tertiary care center of central India for a period of 1 year were included in this study. Clinical data were obtained from case notes. HbF of infants was measured in the blood sample using high?performance liquid chromatography at the first visit and after 1 month follow?up and was analyzed statistically. Dilated fundus examination was done as per ROP screening guidelines, and ROP was classified as per the International Classification of Retinopathy of Prematurity (ICROP), 2021. The study subjects were divided into two groups based on the status of ROP. The relationship among HbF, blood transfusion, and ROP was evaluated in both the groups. The relationship between other clinical characteristics and various neonatal risk factors was also studied between the groups. Results: A total of 410 preterm infants were included in this study, of which 110 infants had ROP (26.8%). Blood transfusion was found to be significantly associated with the development of ROP. Higher fraction of HbF (%) was associated with a lower prevalence of ROP. HbF was also inversely related with the severity of ROP. Conclusion: Replacing HbF by adult hemoglobin during blood transfusion may promote the development of ROP. Conversely, maintaining a higher percentage of HbF may be a protective factor against ROP.
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Acute kidney injury (AKI) is common in critically ill patients, afecting almost one in four critically ill children and one in three neonates. Higher stages of AKI portend worse outcomes. Identifying AKI timely and instituting appropriate measures to prevent and manage severe AKI is important, since it is independently associated with mortality. Methods to predict severe AKI should be applied to all critically ill patients. Assessment of volume status to prevent the development of fuid overload is useful to prevent adverse outcomes. Patients with metabolic or clinical complications of AKI need prompt kidney replacement therapy (KRT). Various modes of KRT are available, and the choice of modality depends most on the technical competence of the center, patient size, and hemodynamic stability. Given the signifcant risk of chronic kidney disease, patients with AKI require long-term follow-up. It is important to focus on improving awareness about AKI, incorporate AKI prevention as a quality initiative, and improve detection, prevention, and management of AKI with the aim of reducing acute and long-term morbidity and mortality
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Sirenomelia also called mermaid syndrome is a congenital, rare, lethal, multisystemic human malformation of unknown etiology. The characteristic feature of sirenomelia is the fusion of the lower limbs, resulting in the appearance of a mermaid’s tail, and thus the name “mermaid syndrome.” This condition is also characterized by various severe urogenital abnormalities and the presence of a singular umbilical cord blood vessel, and it is more common in infants of diabetic mothers and in monozygotic twins. The incidence is around 1 in 60,000–70,000 pregnancies. The majority of affected fetuses are stillborn, whereas the rest of the live-born die in the early neonatal period due to complications of the gastrointestinal and urogenital systems. We are reporting a case of sirenomelia in a neonate born to an unregistered multipara mother. The baby had perinatal asphyxia, sirenomelia, dextrocardia, low set ears, lymphatic malformation, bilateral renal agenesis, absent external genitalia and anus, single umbilical artery, and congenital corneal clouding. There was no antenatal ultrasonography done and the baby died at 6 h of life.
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Objectives: This prospective observational study aimed to identify the current trend of the circulating viral strains responsible for hand foot mouth disease (HFMD) outbreak in four tertiary care centers in Rajasthan, amidst the coronavirus disease (COVID-19) pandemic (April-October 2022). Methods: Cases with suspected HFMD, presenting to our skin outpatient department were assessed clinically and serologically (IgM antibodies against coxsackie virus (CV) A6, A16 and enterovirus 71) for evidence of the disease. Results: We identified 718 new HFMD patients (161 adults) with peaks in May and August, 2022. Male:female ratio decreased with increasing age. Most children were asymptomatic. A total of 385/409 patients assessed serologically, were found positive, most commonly against CV-A6. Conclusion: Though HFMD typically affects young children, an unusually higher proportion of adults were affected during the current pandemic. There were some differences between pediatric and adult presentation of HFMD.
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Purpose: To assess the knowledge of nursing staff on ocular care in medical intensive care unit (ICU) and to compare the incidence of ocular surface disorders in patients of medical ICU pre? and post?training. Methods: Two hundred patients admitted in medical ICU for more than 24 h underwent a detailed ocular examination along with documentation of ICU stay, ventilation status, and Glasgow coma scale (GCS) scoring. An assessment on ocular care knowledge among the nursing staff of medical ICU was done. They were further given training in the form of audio?visuals and demonstration, and an eye care protocol was given to them. The second phase of the study was carried out in the same manner. A comparison was made between pre?training and post?training incidence of ocular surface disorders among ICU patients. Results: Ventilated patients had more eye discharge. Incidence of eye discharge was more in patients with duration of stay of more than 7 days in ICU. Ocular surface disorders closely correlated with the degree of lagophthalmos. There was significant reduction in ocular morbidity following ocular care training of the nursing staff. Conclusion: Eye care is a very important part of nursing care in sedated and ventilated patients in the ICU. Ophthalmic consultations are routinely needed in ICU subjects who are hospitalized for more than 1 week or if the ICU staff suspects any eye problems.
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Introduction: The aim of this study was to compare the fracture resistance of simulated immature teeth using four different apical plug materials, i.e. Pro? Root MTA, Neo? MTA Plus, Biodentine, and Bioactive Glass. Materials and Methods: 80 extracted human maxillary anterior teeth were divided into 4 groups for this study. They were prepared using Peeso reamers to simulate immature teeth and to mimic Cvek’s stage 3 of root development. A 5 mm apical barrier was placed using different materials. The remaining canal was obturated using gutta?percha and AH plus sealer. The final samples were stored at 37°C and 100% humidity for 4 weeks. Fracture resistance of the teeth was measured in Newtons using a universal testing machine. The comparison of fracture resistance between the four groups was done using Kruskal Walis ANOVA followed by post hoc Mann Whitney U test for pairwise comparison. Results: Biodentine group showed the highest fracture resistance as compared to the other three groups and the difference was highly significant (P < 0.001). Conclusions: Biodentine can be advocated over MTA as an effective material for the management of teeth with wide open apex. Bioactive glass also has shown promising results in increasing the fracture resistance of simulated immature teeth.
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Purpose: To compare the effect of audiovisual and verbal instructions on patient performance while performing automated Humphrey visual field testing. Methods: This was a prospective study. A total 120 patients divided into groups of 40 each were recruited from the glaucoma outpatient department (OPD). All patients were aged 35–75 years with no previous experience of performing HFA. Patients with hearing impairment, any other cognitive impairment, and best?corrected visual acuity (BCVA) ?6/36 on Snellen’s visual acuity were excluded. The first two groups were given strict (conservative) and lenient (liberal) verbal instructions. The instructions were adapted from those listed in the manufacturer’s instruction. and the third group was shown a standard video depicting in detail how perimetry was to be performed. A questionnaire was given to each patient before and after the test to assess the patient’s performance. Results: Patients diagnosed with glaucoma during testing in each group were 29 (72.50%), 30 (75.0%), and 33 (82.5%) in the video instructed, strictly verbal, and leniently verbal groups, respectively. The overall mean deviation (MD) in the right eye (RE) was of ? 3.38 (?4.9 to 1.9) and in the left eye (LE) was ? 3.96 (?6.4 to ? 1.9). Reliable field was slightly higher for the video instructed group (47.5%) and lowest for the strictly verbal group (22.5%) (P = 0.033). A higher number of patients were very motivated in the video instructed group (27%) (P = 0.041). Post?test questionnaires showed that 40% of patients felt they have performed the test with 100% accuracy in video group with less guessing. A higher number of patients in the video instructed group (85%) felt instruction was helpful in performing the test (P = 0.001). Conclusion: The video groups were more motivated and had better confidence to perform the test with less anxiety and stress and with probably better understanding of the procedure due to visual effects enhancing their understanding.
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Introduction: An ideal induction agent for general anesthesia should have hemodynamic stability, minimal respiratory side effect and rapid recovery. Presently etomidate and propofol are popular rapid acting inducing agents. Material and methods: After obtaining informed written consent from patients this prospective, randomized, double blind study was conducted in 100 patients of ASA grade 3 and 4 posted for elective surgeries under general anaesthesia. They were divided into two groups of 50 in each group based on random number as group A and group B. The patients in Group A given Inj. Propofol and the patients in Group B received Inj. Etomidate. Parameters such as heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure and spo2 were monitored continuously and recorded. Incidence and degree of pain of myoclonic movements were recorded. Demographic variables such as age,Result: gender, weight and ASA grade were comparable no significant difference existed between both the groups.Baseline mean heart rate, mean systolic blood pressure and mean diastolic blood pressure were comparable in both the Groups. (P>0.05)Significant (P<0.05) fall in mean systolic blood pressure, mean diastolic pressure and mean arterial pressure was observed immediately after induction, at 2, 5, 10 minutes up to 30 minutes in group A (propofol) compare to group B (etomidate). After then no significant difference seen in mean systolic pressure, mean diastolic pressure and mean arterial pressure. Etomidate was found ideal for its hemodynamic stability when compared to PropofolConclusion: along with less incidence of pain on injection, the only drawback being high incidence of myoclonus elderly patient.
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Introduction : The medical personnel especially have to deal with both the Biological and Psychological consequences originating from the influence of virus. Emergency Care Units equipped with ambulance service always should be at the fore front to face all emerging untoward incidents. Ambulance Drivers often disregard their physical health and mental stress in order to fulfil the duties entrusted on them. Methodology : Cross-sectional questionnaire based on-line survey was conducted. Ambulance drivers were North and South India were taken as study subjects. Knowledge based questions and mental stress were assessed using Perceived Stress level Scale (PSS). The questionnaires were translated toTamil, Kannada, Telugu, Malayalam and Hindi languages. Chi-square test was done to find the association between variables. Results : Among the 101 respondents, 84.2% were having good knowledge about the pandemic. Statistically significant association between number of patients transported per day and the knowledge levels of Ambulance drivers was found (p =0.048)(Chi-square value=15.65). Drivers in Government sector were having more knowledge compared to private sector (p =0.038)(Chi square value=6.53). The perceived mental stress was found to increase with a greater number of patients being transported per day, which was statistically significant (p =0.001)(Chi-square value= 30.42). Conclusion : Knowledge regarding COVID-19 virus was adequate among the Ambulance Drivers. Knowledge was found to be more among drivers who work in Government medical establishments. Mental stress was more among drivers who transported more than 5 patients per day.
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A poisonous plant is defined as a plant that when touched or ingested in sufficient quantity can be harmful or fatal. Many plants are harmful to people when consumed or through skin contact with plant chemicals. Poisonous medicinal herbs are used to treat a variety of illnesses, including diabetes, cancer, infection, and fungal growth. According to the review, numerous phytochemical components that have diuretic, purgative, laxative, anti-allergic, and other significant therapeutic effects have been identified from a variety of medicinal plants. If utilized appropriately, poison can be life-giving, calming to the three Doshas, encouraging, and regenerating. The poisonous plants categorized in Visha and Upvisha in Ayurveda texts. Agadtantra is an important branch of Astanga Ayurveda. Importance of this branch has been described in our Vedas, Epics, and Samhita. Proper description, classification, clinical features, and management of any kind of Visha has been described in this branch. Name of some poisonous plants are Dhatura, Vatsanabha, Bhallataka, Bhanga, Kuchala, Vacha and Gunja etc. Shodhana process is the only bridge between Visha and Aushadhi. Shodhana is the process by which physical, chemical and natural impurities are removed. It will intensify the potency, effectiveness of drug, nullify the toxicity. The aim of this review article is to provide a brief overview of the numerous medicinal uses of some poisonous plant.
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For beginner surgeons, it is difficult to recognize the posterior capsule during cataract surgery. In the case of brown cataracts with a thin posterior capsule and in cataracts with asteroid hyalosis, it is difficult to identify the capsule before intraocular lens (IOL) implantation even for expert surgeons. Here we illustrate five important signs, which can be practiced in routine cases to make sure the posterior capsule is intact, before IOL implantation.
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ABSTRACT Biliary adenofibroma (BAF) is an uncommon liver tumor with a high propensity for malignant transformation. The histomorphology of BAF with malignant transformation can show a spectrum of changes ranging from benign, dysplastic to frank malignancy. Thus, the diagnosis of BAF imposes the pursuit of dysplasia/ malignancy focus. We presented a case of intrahepatic cholangiocarcinoma arising from BAF in a 49-year-old woman with detailed histomorphology. We also performed a PubMed database search and tabulated all previously reported cases of BAF with dysplasia/ malignant transformation. A statistic comparison of age, sex ratio, size of the tumor, and survival following complete resection between BAFs with and without dysplasia/ malignancy from the retrieved data is presented. Our analysis did not highlight any statistically significant difference between BAFs with and without dysplasia/ malignancy in age, sex ratio, tumor size, and survival following complete surgical resection. Our study highlights the histopathology and immunohistochemistry of a case of BAF with malignant transformation and highlights the importance of this diagnosis in management. Further longitudinal studies on a larger cohort of patients are required to validate our findings.
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Background@#Dental anxiety is a matter of serious concern to pediatric dentists as it may impede the efficient delivery of dental care. If not adequately resolved, a persistent negative response pattern may emerge. Thaumaturgy, commonly known as magic trick, has become popular recently. It is a tool that distracts and relaxes the child by using magic trick while the dentist performs necessary treatment. Hence, the aim of this study was to evaluate the effectiveness of Thaumaturgic aid in alleviation of anxiety in 4–6 – year-old children during administration of local anesthesia using the inferior alveolar nerve block (IANB) technique. @*Methods@#Thirty children aged between 4–6 years with dental anxiety requiring IANB were included in this study. Patients were divided equally into two groups: Group I, thaumaturgic aid group and Group II, conventional non-pharmacological group using randomization. Anxiety was measured before and after using the intervention with Raghavendra Madhuri Sujata-Pictorial scale (RMS-PS), Venham’s anxiety rating scale, and pulse rate. All the data were tabulated and compared using statistical analysis. @*Results@#Children in thaumaturgy group (Group- I) exhibited significantly lower anxiety during IANB in comparison with children in the conventional group (Group- II) and the difference was statistically significant. @*Conclusion@#Magic tricks are effective in reducing anxiety among young children during IANB; Moreover, it expands the arsenal of behavior guidance techniques for treatment of children with anxiety and plays an important role in shaping the behavior of a child in pediatric dentistry.
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The posterior inferior cerebellar artery (PICA) is often involved in pathologies of the posterior cranial fossa. Therefore, a good understanding of the vessel’s normal and variant courses is important to the neurosurgeon or neurointerventionalist. During the routine microdissection of the craniocervical junction, an unusual arrangement between the highest denticulate ligament and PICA was observed. On the right side, the PICA was given rise to by the V4 segment of the vertebral artery 9 mm after the artery entered the dura mater of the posterior cranial fossa. The artery made an acute turn around the lateral edge of the highest denticulate ligament to then recur 180 degrees and travel medially toward the brainstem. Invasive procedures that target the PICA should be aware of the variant as described herein.
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Digital health services in recent times furnish health education, awareness, monitoring of vitalsigns, disease prediction and also can be used as diagnostic tools, primarily through machinelearning and deep learning applications. These big datasets acquired through digital health lay outthe disease trends, patient health insights and act as a better predictor of future health outcomes.Cardiovascular diseases (CVD) outcomes have been seen to have decreased significantly withapplication of digital health outcomes in Western countries. The deaths from CVD in India have risen from 2.26 million in 1990 to 4.77 million in 2020.Using digital technologies to promote healthy lifestyle changes embracing healthy behaviors cansupport early diagnosis, effective management and appropriate clinical decisions. This focus ifadopted in India can bring dynamic changes in the CVD health scenario essentially tackling theburden of cardiovascular diseases.
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Purpose: To study the clinical and demographic profile of patients less than 40 years of age presenting to glaucoma services including the reasons for referral. Methods: Patients in the age group of 5 to 39 years, visiting the glaucoma clinic, who were either suspected to have glaucoma or who had been newly/previously diagnosed with glaucoma were included in the study. After informed written consent, basic demographic details of the participants including age, gender, education, socioeconomic status, and family history were obtained. A comprehensive ophthalmological evaluation was performed by glaucoma specialists. Results: The proportion of glaucoma in the study population (n = 384) was found to be 31.25%, and the incidence of glaucoma among new patients was found to be 11.9%. Among all glaucomas (n = 120), 44.2% of patients had secondary glaucomas, 27.5% had primary glaucomas, and 28.3% had congenital glaucomas. Also, 67.3% of all glaucoma patients were males. Newly diagnosed glaucoma patients presented with a mean intraocular pressure (IOP) of 32.9 mmHg and mild–moderate disc damage with a mean cup?disc ratio of 0.65. Nearly one?third of them had a presenting visual acuity worse than 5/60. The most common reason for referral was raised IOP. Univariate and multivariate analysis revealed that the odds of developing glaucoma were less in females (P = 0.04) and in patients with a higher standard of living index (P < 0.001). Conclusion: One?third of the patients had glaucoma and another one?third were suspects. Secondary glaucomas are more common than primary/congenital glaucomas. A comprehensive eye evaluation is a must, especially in those with predisposing factors.
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Purpose: This study was conducted to ensure the integrity of surgery wounds. Methods: This was a randomized prospective trial of 300 patients who underwent small-incision cataract surgery (SICS) at our hospital over a one-year period. We used 2�drops of 5% povidone-iodine at the end of each case, not only to disclose any wound leaks but also to sterilize the surface of the eye. Results: Three hundred patients underwent SICS. One hundred ten patients had postoperative wound leak in SICS due to surgical complications. Premature entry comprising 75% (83 cases), followed by floppy iris syndrome comprising 20% (22 cases) and 5% (6 cases) comprising pseudoexfoliation (PXF) syndrome. There was a drop in the number of re-surgeries from 12 to 3 cases since we started implementing this technique. Conclusion: The simple procedure is very handy and economical in identifying the leak and can reduce further complications such as endophthalmitis and re-surgeries. Among residents, this can be a boon where povidone-iodine acts as a riverbank for the outflow of aqueous, outlining the speed, location, and quantity of the leak. Siep抯 test plays an important role in identifying any postoperative wound leaks and also sterilizing the eye surface post surgery.
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Purpose: Pseudoexfoliation is an age-related fibrillopathy characterized by the deposition of fibrillar material in the eye with an increased risk of complications during cataract surgery. Aim was to study visual outcomes and complications in patients with pseudoexfoliation undergoing manual small-incision cataract surgery (MSICS). Methods: Prospective observational study was performed on 152 patients with pseudoexfoliation above 50 years undergoing MSICS in a tertiary hospital from December 2016 to November 2017. Intraoperative and postoperative complications were documented with follow-up on postoperative day 1, 1st week, 1st month, and 3rd month. Results: Preoperative small pupil was noted in 49 eyes (32.2%), and 19 (12.5%) required intraoperative measures. Intraocular complications noted were zonular dialysis in five (3.3%), posterior capsular rupture in one (0.7%), and iridodialysis in one (0.7%). On postoperative day 1, the most common complication was corneal edema in 134 patients but clinically significant in only 23 (15.1%). Postoperative complications at 3 months were irregular pupil in 17 cases and decentered IOL in three cases. Intraocular pressure decreased with each visit [preoperative mean: 14.39 (�4) and 13.37 (�0) 12.53 (�4) mm Hg at 1 and 3 months, respectively]. There was a significant improvement in vision from the first day mean pinhole vision of 0.26 (�24) to mean best corrected visual acuity (BCVA) of 0.09 (�22) and 0.07 (�22) at 1 and 3 months, respectively. Mean endothelial cell loss was 193.16 (7.79%) and 266.01 (10.68%) at 1 and 3 months, respectively. Conclusion: Pseudoexfoliation has an increased risk of complications during cataract surgery. MSICS gives good outcomes in terms of visual recovery and postoperative outcomes
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A 17-year-old underweight boy came with a classical emergency of diabetic ketoacidosis associated with two additional clinical features; persistently low blood pressure despite adequate fluid resuscitation and hypogonadal features with Tanner stage 3 pubic hair, absent facial, and axillary hair along with a high-pitched voice. These findings triggered an endocrine workup which revealed hypogonadotropic hypogonadism. Suspecting primary pituitary pathology, an magnetic resonance imaging brain, was done which showed a well-defined hyperintense lesion in the pituitary suggestive of pituitary apoplexy. In the absence of headache, diplopia, and visual field defects, this incidental finding posed a dilemma regarding the diagnosis and management of diabetic ketoacidosis in the presence of apoplexy.