ABSTRACT
ABSTRACT Ovarian steroid cell tumors are rare, representing less than 0.1% of all ovarian neoplasms. Among the myriad causes of hirsutism, ovarian tumors account for 1% of the reported cases. We present the case of a 49-year-old parous postmenopausal woman who sought medical attention for hirsutism for 2 years. This case illustrates the unusual and interesting connection between rare ovarian pathology and the clinical manifestation of hirsutism in a postmenopausal patient. Her ultrasonography and MRI showed a right adnexal mass of solid-cystic consistency with thin septations. Her laboratory workup revealed high levels of total testosterone of 256 ng/ml (8.4-48.1ng/ml) and free testosterone of 7.36 pg/ml (0.2-4.1 pg/ml), while DHEAS - 234 µg/dl (35.4-256 µg/dl) and CA125 - 15.8U/L (0.0-35 U/L) were in the normal range. She underwent exploratory laparotomy with a total abdominal hysterectomy and oophorectomy. Histopathological examination and immunohistochemistry conclusively established the presence of a steroid cell tumor, specifically classified as "Not Otherwise Specified"(NOS), in the right ovary.
ABSTRACT
This article explains a technique of scleral fixation of intraocular lens (SFIOL) by using a 30?gauge (g) needle. Background: The X?nit needle by “Aurolab” uses a 26?g needle, while in this technique, a 30?g needle is used, thus reducing the incision size and relevant complications. Purpose: In this technique, glue or end-gripping forceps are not used, thus making it hassle free and more economical. There is no dependency on assistant; because of using 30 g needle, bleeding is minimal and wound healing is faster. Synopsis: A 30?g needle is bent at 3/4–1/4 junction (from the tip) and a piece of 240 silicon band is inserted into the needle to be used as a stopper. After completing vitrectomy, a 1.5?mm marking is done perpendicular to the limbus at 3’o clock and 9’o clock positions. Another marking is done 1.5 mm away from the first mark parallel to the limbus. A 30?g needle is inserted into partial?thickness sclera from the second mark toward the first marking, thus making a tunnel. The needle is penetrated into the sclera to enter in the vitreous cavity. The needle is then progressed toward the anterior vitreous cavity and brought out through the lip of previously made scleral tunnel in the superior quadrant. The tip of leading haptic of three?piece intraocular lens (IOL) is fed into the tip of needle and gradually, the needle is withdrawn. As soon as the tip of needle is visualized, the piece of band is gradually slipped into the haptic and the needle freed from the haptic. In a similar fashion, the trailing haptic is withdrawn from the opposite side. The bands are removed and the haptics are adjusted by pulling or pushing to centralize the IOL in the pupillary axis. Haptics are trimmed and ends are cauterized to make them blunt. Tunnel and conjunctiva are sutured with one or two (8?0) absorbable Vicryl sutures. The 25?g ports are removed and no suturing of ports is done. Highlights: It is a minimally invasive and glueless technique in which end?gripping forceps is not used. So, it is very economical with faster wound healing and minimal bleeding and no post?op hypotony. Since the temporal scleral flaps are not made and 30 g needle is used so minimal invasive. Astigmatiam induced by scleral tunnel is seen i;e about 0.75 ? 1.15 D of cylinder.
ABSTRACT
Background: Subarachnoid block has been used for intracavitary radiotherapy (ICRT) for carcinoma cervix, but the literature on the appropriate dose of local anesthetic required to achieve the desired effect is lacking. We compared two different intrathecal doses of 0.5% hyperbaric bupivacaine (1.2 and 1.5 mL) for providing optimal surgical conditions and readiness to discharge in patients undergoing ICRT for carcinoma cervix. Materials and Methods: This prospective double?blind study was done in 80 patients undergoing ICRT. The patients were randomized into two groups (Groups I and II) to receive 1.2 and 1.5 mL of intrathecal hyperbaric bupivacaine, respectively, for ICRT. The level of sensory achieved, the patient satisfaction score, radiation oncologist score, time to L5 regression, and time to motor recovery (walking unaided) were assessed. Statistical Analysis Used: The data were analyzed using SPSS 20 for Windows (IBM, Chicago, IL, USA). Results: The time taken for the block to regress to L5 (Group I: 134.6 � 32.4 minutes vs. Group II: 143.2 � 43.0 minutes, P = 0.31) were comparable. However, the mean time for walking unaided (Group I: 220.87 � 47.12 minutes versus Group II: 247.00 � 49.83 minutes, P = 0.032) after the subarachnoid block was significantly less in Group I. The patient satisfaction with the procedure and overall satisfaction of the radiation oncologists regarding the operating condition were comparable in both the groups. Conclusions: Hence, a 1.2 mL dose of intrathecal hyperbaric bupivacaine for ICRT provides optimal surgical conditions with hemodynamic stability and ensures the early discharge of the patient.
ABSTRACT
Objective: To evaluate the prevalence of vitamin D deficiency (VDD) and its correlates among apparently healthy children and adolescents. Methods: We carried out a secondary analysis of data of Comprehensive National Nutrition Survey 2016-18 to analyze the pre-valence and predictors of VDD among Indian children and adolescents. Results: The over-all prevalence of VDD in preschool children (1-4 years), school age (5-9 years) children, and adolescents (10-19 years) was 13.7%, 18.2%, and 23.9%, respectively. Age, living in urban area, and winter season were significantly associated with VDD. Vegetarian diet and high-income households were the main risk factors observed in 5-19 years age category. Female sex and less than three hour of physical activity/week were independent risk factors among adolescents. Conclusion: The prevalence and determinants of VDD across different age-groups are reported, and these should be interpreted and addressed to decrease the burden of VDD in India.
ABSTRACT
Background: The epidemic of coronavirus disease 2019 (COVID-19) has been rapidly spreading on a global scale affecting many countries and territories. There is rapid onset of generalized inflammation resulting in acute respiratory distress syndrome. We, thus, aimed to explore the potential of immune-inflammatory parameters in predicting the severity of COVID-19. Materials and Methods: Age, neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), platelet-to-lymphocyte ratio (PLR), Lactate Dehydrogenase (LDH), C-reaction protein (CRP), and procalcitonin (PCT) of 611 patients with laboratory-confirmed COVID-19 were investigated and compared. Patients were divided on the basis of severity and survival into two groups. Data were expressed as mean or median values and percentages. The receiver operating characteristic curve was applied to determine the optimal cut-off values of these biomarkers. Results: The median age was 50 years and the male to female ratio was 3.7:1. The mean NLR, LMR, PLR, LDH, CRP, and Procalcitonin for the non-severe group were 4.16, 10.8, 133.7, 666.1, 49.9, and 0.15, respectively. In the severe group mean values of the above-mentioned immune-inflammatory markers were 17.8, 4.69, 268.2, 1277, 158.6, and 3.05, respectively. Elevated levels were significantly associated with disease severity. In ROC curve analysis, NLR had the largest area under the curve at 0.923 with the highest specificity (0.83) and sensitivity (0.88). Conclusion: This study shows that NLR, PLR, LDH, CRP, and Procalcitonin may be a rapid, widely available, useful predictive factor for determining the severity of COVID-19 patients.
ABSTRACT
Painful menstrual cramps during or around the time of the monthly cycle are known as dysmenorrhea. The estimated global prevalence in women of reproductive age ranges from 45% to 95%. It has a significant negative impact on regular activities and productivity at work. However, despite the severe consequences on quality of life, primary dysmenorrhea (PD) is underdiagnosed. Dysmenorrhea has complex pathogenesis. It involves the release of prostaglandins and activation of the nucleotide-binding oligomerization domain-like receptor protein 3 (NLRP3) inflammasome and also includes the involvement of other mediators such as bradykinin, histamine and acetylcholine. Even though nonsteroidal anti-inflammatory drugs (NSAIDs) remain the most common type of pain medication, the question of which one should be the most preferred is still open to debate. The current review examines the existing evidence for the pathogenesis of PD and makes evidence based and clinical experience based recommendations for the use of mefenamic acid and its combination in the treatment of dysmenorrhea. Mefenamic acid alleviates PD by inhibiting endometrial prostaglandin formation, restoring normal uterine activity, and reducing the inflammatory response by inhibiting the NLRP3 inflammasome and reducing the release of cytokines such as interleukin (IL)-1?. It is also known to have bradykinin antagonist activity. Dicyclomine has a dual action of blocking the muscarinic action of acetylcholine in postganglionic parasympathetic effect or regions and acting directly on uterine smooth muscle by blocking bradykinin and histamine receptors to relieve spasms. According to the experts, mefenamic acid and dicyclomine act synergistically by acting on the different pathways of dysmenorrhea by blocking multifactorial agents attributed to the cause of dysmenorrhea. Hence, the combination of mefenamic acid and dicyclomine should be the preferred treatment option for dysmenorrhea.
ABSTRACT
Milk production of the mammary gland is mainly determined by the milk synthesis and proliferation abilities of mammary epithelial cells (MECs). The availability of amino acids is critical for the production of milk. Amino acids enhance milk protein synthesis and mammary gland development through the mechanistic target of rapamycin (mTOR) pathway. Taurine enhances lactation by increasing prolactin secretion. Vitamins such as Thiamine and Pyridoxine are essential for maintaining and growing maternal and child health. However, there is a paucity of data regarding the safety and efficacy of amino acids and vitamins combination in lactating mothers with insufficient lactation. Hence, a prospective study was conducted to assess the safety and efficacy of a novel amino acids and vitamins combination. The results showed that with the intervention of this combination, 62% of participants showed onset of lactation within 45 minutes to 2 hours. The study suggests clinicians should consider this novel combination to improve lactation in insufficient lactating mothers
ABSTRACT
Background: Iron-folic acid deficiency is the most common complication during pregnancy. Iron deficiency is responsible for various health complications among pregnant women. Compliance with IFA supplementation is variable across India several factors are associated with compliance with IFA supplementation. Objective: The objective of this systematic review is to assess the factors affecting compliance toward oral iron-folic acid supplementation among pregnant women in India. Methods: The primary search was carried out using PubMed, Google scholar, the WHO website, and Research Gate which provide access to full?text research articles from January 2012 to 25th January 2022 published data were searched. Result: A total of 74 studies were identified, and 20 were included in this review. Out of the 20 studies, sixteen were cross-sectional, two mixed methods, and two randomized control trials. knowledge of IFA, education, socioeconomic status, the timing of registration and number of antenatal visits, type of family, and age of the pregnant women were the factors that affect the compliance of IFA supplementation. Conclusion: Knowledge of iron-folic acid supplementation, Timing of registration and number of Antenatal Care visits, educational level of the pregnant women, and age of the pregnant women were factors associated with the compliance of IFA supplementation among pregnant women in India.
ABSTRACT
Purpose: To determine the incidence of vitreous loss and visual outcome after a vitreous loss during cataract surgery performed by surgeons with various levels of experience in adults >40 years of age at a tertiary eye care center in North India. Methods: The study was conducted at a tertiary eye care center in North India. This was an observational, retrospective, cross-sectional study of patients who underwent cataract surgery from August 1, 2011 to July 31, 2014. All adult cataract cases who were operated on from August 1, 2011 to July 31, 2014 and who experienced vitreous loss during their surgery were included in the study. The visual outcomes of these patients who experienced vitreous loss during cataract surgery in uncomplicated cataract and were managed using standard automated vitrectomy techniques were assessed for different cataract surgical techniques (extracapsular, small-incision, and phacoemulsification) as well as at different levels of skill of the operative surgeon (consultant, short term fellow, and long-term fellow). Details of the postoperative period and best-corrected visual acuity (BCVA) were collected from patient records by the principal investigator on day 1, 1 week, 4 weeks, 6 weeks, and 3 months post cataract surgery. Results: Vitreous loss occurred in 374 out of 18,430 patients who underwent cataract surgery from August 1, 2011 to July 31, 2014. The overall incidence of vitreous loss in our study was found to be 2.03% with consultants having a rate of 1.66%, short-term fellows at 5.19%, and long-term fellows at 2.02%. Two hundred eighty-eight patients of the 374 cases followed up for 3 months at the hospital and 75.69% of these patients had a final visual acuity of ?6/18. Conclusion: In an institute with a structured training program for residents/trainees, the vitreous loss rate is low during cataract surgery. Early intervention and proper management with the standard microsurgical technique by experienced hands can improve the final visual outcome in eyes with vitreous loss. Cystoid macular edema and corneal edema were the most common causes of poor postoperative vision
ABSTRACT
Mucormycosis has emerged as an important fungal infection with high associated mortality rates. Mucormycosis causes devastating angio-invasive fungal infections, primarily in patients with underlying risk factors. The prevalence of mortality associated with invasive Mucormycosis is high (>30-50%), with 90% mortality contributed by disseminated disease. Sudden rise in Mucormycosis cases during the COVID-19 pandemic came as a surprise to all. Lowered immunity due to COVID and associated conditions like diabetes, made the population susceptible to this dreaded disease. This disease led to both increase in morbidity and mortality among the general population. Aim of the Study : To interpret in detail the causes of mortality of patients presenting with COVID Associated Mucormycosis (CAM-19) at AIIMS Patna between May-November, 2021. Materials and Methods : An observational study of all patients who were treated for mucormycosis during the period of May 2021-Nov 2021 in ENT Department, AIIMS, Patna. During the period of study, 219 patients of RhinoOrbital-Cerebral Mucormycosis (ROCM) were admitted for treatment. Five patients had gone on Leave Against Medical Advice (LAMA). So, 214 patients were included in the study. Results : Among the 214 patients, 165 patients were treated surgically through both endoscopic and open approaches along with antifungal therapy management. 41 patients died during the hospital course of the treatment. The mortality rate of ROCM stood at 19.15% in our series. Pulmonary Mucormycosis had high mortality (100%). Diabetes is the most common risk factor. Multiple co-morbidities and extensive intracranial involvement had a strong association with mortality. Conclusion : The advanced stage of ROCM was associated with more deaths. Our series mortality rate of 19.15% is lower than most of the other documented mortality rates. Our results support that early aggressive surgical approach, antifungal therapy and multidisciplinary approach has reduced the mortality
ABSTRACT
Hepatitis C virus (HCV) infection affects kidneys with different histopathological patterns on kidney biopsy, which commonly include membranoproliferative glomerulonephritis (MPGN) pattern with mixed cryoglobulinemia (CG), thrombotic microangiopathy, membranous nephropathy and small to medium vessel vasculitis. Type 1 MPGN associated with type II mixed CG is the most common glomerulopathy associated with hepatitis C infection. Treatment of these glomerulopathies and cryoglobulinemic renal disease associatedwith HCV infection includes antiviral therapy for HCV, B-cell depletion therapy for prevention of immune complexes and cryoglobulins or nonspecific immunosuppressive therapy. We describe a patient who presented to us with HCV associated MPGN type 1 with cryogloblinemia and detectable HCV RNA, who recovered completely with directly acting antiviral agents (DAA) alone without immunosuppression.
ABSTRACT
Abstract Background Breast cancer surgery is associated with considerable acute post-surgical pain and restricted mobility. Various regional and neuraxial anesthesia techniques have been used to alleviate post-mastectomy pain. Ultrasound-guided serratus anterior plane block (SAPB) has been considered a simple and safe technique. This randomized control study was performed to compare the efficacy of SAPB with the thoracic paravertebral block (TPVB) for postoperative analgesia after breast cancer surgery. Methods A total of 40 adult ASA physical status I - II female patients undergoing radical mastectomy were randomly allocated into two groups to receive either ultrasound-guided TPVB or SAPB with 0.4 mL.kg-1 0.5% ropivacaine, 30 min before surgery. All patients received standardized general anesthesia for surgery. Injection diclofenac and tramadol were used for postoperative rescue analgesia. The time to first rescue analgesia, total analgesic consumption in the first 24 hours, postoperative pain scores, and any adverse effects were recorded. Results The time to first rescue analgesia was significantly longer in the SAPB group (255.3 ± 47.8 min) as compared with the TPVB group (146.8 ± 30.4 min) (p< 0.001). Total diclofenac consumption in 24 hours was also less in the SAPB group (138.8 ± 44.0 mg vs 210.0 ± 39.2 mg in SAPB and TPVB group respectively, p< 0.001). Postoperative pain scores were significantly lower in the SAPB group as compared with TPVB group (p< 0.05). The incidence of PONV was also less in the SAPB group (p= 0.028). No block-related adverse effects were reported. Conclusion We found that the serratus anterior plane block was more effective than the thoracic paravertebral block for postoperative analgesia after breast cancer surgery.
Subject(s)
Humans , Female , Adult , Middle Aged , Breast Neoplasms/surgery , Analgesia , Pain, Postoperative/etiology , Pain, Postoperative/prevention & control , Pain, Postoperative/drug therapy , Diclofenac , Ultrasonography, Interventional/methods , Mastectomy/adverse effectsABSTRACT
Lower segment cesarean section (LSCS) is a safe mode of delivery and has definite indications. However, at times, patients do not accept the advice to undergo elective or emergency LSCS, as appropriate. This leads to avoidable complications and cost. This communication discusses the style and salient features of counseling patients to understand and accept LSCS, as part of informed consent-taking. This discussion is geared towards obstetric care providers who encounter LSCS hesitancy in spite of having explained the indication(s) for surgery.
ABSTRACT
In women in whom a normal vaginal delivery is not possible or is not indicated, delayed acceptance of lower segment cesarean section (LSCS) or outright LSCS refusal, leads to complications that can easily be avoided. Hence, it makes sense for obstetricians and other health care professionals, to address LSCS hesitancy as an integral part of obstetric care. In this article, we discuss both the communication style and communication content, that is required to manage LSCS hesitancy in women in whom the intervention is indicated. We highlight the need to analyze the reasons for hesitancy, and address them in an appropriate and affable manner, using accurate information to buttress one’s points. We also encourage seeking assistance from colleagues in the health care team, utilizing audio-visual and social media aids, and offering alternatives if the patient so desires.
ABSTRACT
Background: Research in India has seldom studied caregivers’ perceptions, experiences, and needs for information and personal support after an autism spectrum disorder (ASD) diagnosis. Objectives: The objectives of the study were to understand the perceived barriers for obtaining a diagnosis and the perspectives and experiences of parents of children with autism. Materials and Methods: Parents with a diagnosed ASD child (within a year of diagnosis) in the 3–8 years range were recruited from the Pediatric Psychology and Neurodevelopmental Clinic from a tertiary care teaching hospital in North India. An interview guide elicited information about experiences regarding obtaining an ASD diagnosis, perceived barriers and facilitators, reactions to diagnosis, postdiagnostic family and community experiences, and stress experienced by parents. Qualitative responses were analyzed using thematic analysis. Participants were recruited till there was a saturation of themes. The ethics clearance was provided by the institutional review board. Results: Twenty-eight caregivers of children with ASD were recruited for the study. Overall, nine themes were identified from the qualitative analysis of the interviews: two before diagnosis (delayed help?seeking and experiences with healthcare), one at the time of diagnosis disclosure (heightened emotional response to diagnosis), and six themes after the diagnosis (increased stress, behavioral challenges, deterioration in family relationships, negative attitudes of the family, seeking support, and moving forward with hope for the future). Conclusions: There are several barriers and gaps in the autism-related available services in the country, and there is a need to provide inclusive, supportive, culturally sensitive, and family-centered model of care for parents raising children with ASD.
ABSTRACT
Introduction: Fetal biometric parameters are very often utilized for calculating gestational age. The pancreas is a gland with dual functions in our body – exocrine and endocrine, with the latter component being very often discussed in the context of diabetes mellitus. Through evaluation of variations in morphometry in relation to different gestational ages, the research intends to draw attention to various associated developmental correlations that were not mentioned in previous studies. MaterialsandMethods: The current research was carried out on 30 fetuses after obtaining due approval from Institute’s Ethical Committee. Fetuses were divided into different gestational age groups and morphometric parameters such as crown‑rump length, crown heel length, head circumference, abdomen circumference, chest circumference, hand length, and Foot Length (FL) were noted by measuring with nylon thread in centimetres. Fetal pancreases were removed after stepwise dissection and pancreatic weight along with length and thickness was measured by Vernier calipers. All the parameters were then compared within different gestational age groups. Results: All the parameters and the age group of fetuses were positively correlated and showed statistical significance.Conclusion: The study would add substantial knowledge in the areas of pancreatic regeneration, surgical pancreatectomy, and treatment protocols for diabetes mellitus and pancreatic cancer. Through evaluation of variations in morphometry in relation to different gestational ages, the research intends to draw attention to various associated developmental correlations
ABSTRACT
Performing capsulorhexis in white intumescent cataracts during phacoemulsification surgery is challenging for cataract surgeons because of high intralenticular pressure and reduced red reflex. Capsulorhexis extension to the periphery of the lens is a common occurrence due to lens intumescence. We used a vitrectomy cutter to create an initial tear in the anterior capsule and simultaneously remove a part of milky fluid coming out of the intumescent lens. Once the lens was decompressed, capsulorhexis was completed using capsulorhexis forceps. This technique helped in controlling capsulorhexis in eyes with intumescent cataracts by reducing the intralenticular pressure and thereby preventing unexpected radial capsular tear
ABSTRACT
Postpartum hemorrhage (PPH) is a major cause of maternal morbidity and mortality. We focus on two innovations by Indian gynecologists, the Panicker’s vacuum suction cannula and the SR suction cannula. These effective devices are economical and easy-to-use, and help prevent and manage PPH. They can also be used to reduce bleeding in non-PPH indications. These Indian innovations are a matter of pride, and need to be studied extensively in diverse settings. This will help ensure that their benefits can be shared across the world.
ABSTRACT
Background: As per Ayurvedic classics, Ras?yana is a term used for unique therapeutic measures intended to improve cognition, memory, physical strength and delay the degenerative processes. Ayush Rasayana A & B are developed from extracts of herbs pertaining rasayana property. Aims & Objectives: To assess the safety and effectiveness of ‘Ayush Rasayana A and B’ in improving physical endurance, quality of life and cognition of elderly. Materials and Methods: This is an open label, single arm, multi-centre study among 256 apparently healthy elderly between 60?75 years. Ayush Rasayan A was given for 6 days and Ayush Rayana B for 180 days. The effect of the trial drug was seen on functional capacity, quality of life and cognitive function and, safety of the intervention was assessed through haematological and biochemical tests, clinical examination and incidence of adverse events. Results: Significant improvement in 6 minute walk test and HMSE score was observed at 187th as compared to baseline (p<0.0001). Quality of life of the participants especially in domains of physical health, social relationship and environment also improved at the end of intervention period (p<0.0001). The haematological and bio-chemical parameters showed no significant changes as compared to baseline and no adverse events were observed during the study. Conclusion: Ayush Rasayana A and Ayush Rasayana B, both were well tolerated by all the participants. This ayurvedic intervention can be safely given to apparently healthy elderly to improve their functionality, quality of life and cognition. However, a randomized controlled trial is warranted to substantiate the efficacy of this drug.