Inferior vena cava collapsibility index and trauma severity in elderly fall injuries

SUMMARY OBJECTIVE: Falls are a serious cause of morbidity and mortality among older people. One of the underlying causes of falls is dehydration. Therefore, ultrasonography has become an essential tool for evaluating volume status in the emergency department. However, the effect of volume status on falls in older people has not been evaluated before. The aim of this study was to determine the relationship between the inferior vena cava collapsibility index and the injury severity score in older patients who presented with fall-related injuries to the emergency department. METHODS: A total of 66 patients were included in the study. The injury severity score was used as the trauma severity score, and the Edmonton Frail Scale was used as the frailty scale. Volume status was evaluated with inferior vena cava collapsibility index. The primary outcome measure was defined as the correlation between inferior vena cava collapsibility index and injury severity score. Secondary outcome measures were defined as the effect of inferior vena cava collapsibility index and injury severity score on hospitalization and mortality. RESULTS: There was no significant correlation between injury severity score and inferior vena cava collapsibility index (p=0.342). Neither inferior vena cava collapsibility index nor injury severity score was an indicator of the mortality of these patients. However, injury severity score was an indicator of hospitalization. The mean Edmonton Frail Scale score was an indicator of mortality among older people who experienced falls (p=0.002). CONCLUSION: Inferior vena cava collapsibility index cannot be used to predict trauma severity in older patients who have experienced falls admitted to the emergency department.

Suction assisted surgical extraction of subcutaneous lipoma

Background: Lipomas are the most common benign mesenchymal tumours in the body. Patients seek their removal due to disfigurement, discomfort or cancerphobia. Historically, open surgical removal was the mainstay of their treatment but striving for less scarring, liposuction is the only new FDA approved alternative. Methods: 56 patients with subcutaneous lipoma of size 3 cm - 10 cm and fulfilling eligibility criteria were selected for this hospital based prospective cohort study after informed consent and Institutional Ethical Committee approval from June 2016 to July 2018. 3 mm irrigation cannula, 5 mm suction cannula, Suction holding tool and Luer lock syringe were used. Lipoma infiltrated with modified Klein solution. Lipoma suctioned out & through the same port, capsule in the cavity was pulled out employing long forceps. Results observed with regards to operative time, post-operative scars, post operative pain and recurrence. Result: A total of 56 patients were enrolled, operated, and observed. Mean duration of lipoma removal surgery was 47.32 minutes. 67.85% patients had pain score 1 after 2 hours of surgery. 100% of patients had healthy scars. 80.4% patients had 0 Vancouver Scarscore after 6 month follow up and only 1 patient had recurrence in 5 months. Conclusions: Our study showed good results in view of postoperative pain and quality of scar. Use of 5 mm cannula gave visually negligible scar with less than 2% recurrence rate. Even though the mean duration of surgery was 47 mins which is more compared to open excision, the good cosmetic result with minimal to no scar prevails over it.

Audit of caesarean deliveries in a tertiary care rural hospital of Bangalore, Karnataka, India

Background: Due to the rise in caesarean section rates Robsons classification system was adopted by WHO as a global standard to asses and audit the caesarean section rates within different hospitals, to reduce the caesarean section rates and the associated complications and also improve patient care along with it. The aim of the present study is to audit the number of caesarean deliveries in the hospital. Objective were to audit the caesarean deliveries in the institution using Robsons classification system as the starting point to find the contributing factors responsible for the caesarean section rates.Methods: This retrospective hospital-based study was conducted at MVJMC and RH. The study included all pregnant patients undergoing caesarean section during the period of one year from March 2023 to February 2024. All the data was entered into Microsoft excel, sheet, which was then classified according to Robson抯 classification system.Results: In our study we noted that the highest percent of caesarean deliveries was noted among multigravida which contributed about 66.5 of the total caesarean deliveries and according to classification 35% of the caesarean deliveries was noted in group 3 with multiparous women of more than 37 weeks in spontaneous labour. Conclusions: Globally accepted Robsons classification should be used for regular audits among hospitals to curb the caesarean section and its associated maternal and perinatal complications in order to improve patient care.

Prediction of esophageal varices in cirrhosis by using splenic stiffness measurement

Background: Predicting esophageal varices in cirrhosis using the measurement of splenic stiffness is an exciting area of study. Vein enlargement in the lower esophagus, known as varices, is a common symptom of cirrhosis caused by portal hypertension. These varicose veins are potentially fatal since they bleed easily. The present study aims to predict the OV in cirrhosis patients by splenic stiffness in and around this region. Methods: After receiving permission from the Institutional Ethics Committee, the study was performed. The present study authors measured splenic stiffness and liver stiffness by using FibroScan in 112 consecutive cirrhotic patients who met the inclusion criteria. Patients were also assessed by hepatic venous pressure gradient (HVPG), upper gastrointestinal endoscopy, liver stiffness, liver spleen diameter to platelet ratio score, and platelet count to spleen diameter ratio. Results: Among 112 patients enrolled, 64 patients had valid liver stiffness and splenic stiffness measurement, and 64 patients had EV (small, n=23 and large n=42). There was a significant difference in median liver stiffness (54.2 vs. 21.3 kPa, p<0.05), splenic stiffness (56.1 vs. 30 kPa, p<0.05), liver spleen diameter to platelet ratio score (6.3 vs. 2.7, p<0.05), and platelet count to spleen diameter ratio (798 vs 1,241, p<0.05) between patients with OV and those without OV. Conclusions: Non-invasive markers, such as splenic stiffness, may help identify individuals with cirrhosis who are at risk of having esophageal varices, especially large ones, and who are at risk of bleeding, the study's authors conclude.

Prediction of preeclampsia by HDP gestosis score

Background: Preeclampsia is a complex obstetrical syndrome and an important contributor to maternal and perinatal morbidity and mortality. A large number of predictive tests and scoring systems have been proposed but ni low resource settings a cheap, quick and reliable scoring system is desirable to adequately predict the risk for all women. This study aimed to study the role of HDP gestosis score in prediction of preeclampsia.Methods: The study was done on 400 antenatal women attending Obstetrics and Gynecology outpatient department of SRN hospital, MLNMC Prayagraj. All enrolled participants were assigned a gestosis score calculated by the ANDROID AP at first visit (<18 weeks of gestation). All women were divided in three groups according to gestosis score of 1, 2 and 3 or more. The participants were then followed throughout pregnancy and development of preeclampsia was noted.Results: Preeclampsia developed in 13.7% of women. THE sensitivity, specificity, positive predictive value, negative predictive value and predictive accuracy of HDP gestosis score were 72.2%, 94.6%, 68.4%, 95.5% and 91.6% respectively.Conclusions: The HDP gestosis score is a simple, cheap, mobile app. Based scoring system which allows provider to quickly assess individual woman risk-for future development of preeclampsia in busy OPD setting. HDP gestosis score is an effective tool to predict at risk women and initiate pharmacological intervention or intensive maternofetal surveillance.

Incidence and outcomes of ventilator associated pneumonia in pediatric patients: an observational study

Background: Ventilator associated pneumonia (VAP) is very common in pediatric intensive care unit (PICU) intubated patients and also responsible for major morbidity and mortality. Usually, it develops after 48 hours of mechanically ventilated patients, its incidence increases as the duration of time increases and it is a major risk factor for VAP. The present study was carried out to know the overall incidence of VAP in mechanically ventilated patients in PICU.Methods: The study was carried out in PICU of the department of pediatrics, B. R. D. Medical College, Gorakhpur from October 2020 to October 2021. Patients aged between 1 year to 15 years were included in the study.Results: There were 50 (59.5%) patients� male and 34 (40.5%) patients� female under investigation. The clinical pulmonary infection score (CPIS) values ranged from the mean value of 4.38�30 at 36th hours to 7.33�92 at 96th hours of intubation. VAP was present in 23 (27.3%) patients while 62 (73.8%) patients were having no VAP. Among VAP associated patients, 14.3% were Acinetobacter positive, 5.95% were Klebsiella positive and 3.57% were E. coli positive.Conclusions: Parameters of CPIS associated with VAP revealed that Acinetobactor was comparative more common organism and the age group of 1 to 5 years was more sensitive. VAP can be reduced by decreasing the duration of mechanical ventilation.

Changes in biomarkers of lipid in juvenile idiopathic arthritis and its association with various disease parameters: a 6-month follow-up study

Background: The objectives of our study were to determine the changes in lipid profile (total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C)) in juvenile idiopathic arthritis (JIA) and assess its association with epidemiological and clinical profile of JIA patients.Methods: This observational study was performed with 46 patients at presentation followed by 38 cases at 3 months and 18 cases at 6 months of follow up. Their demographic profile and clinical parameters including juvenile disease activity score (JADAS 27) were compared with the biomarkers of lipid profile.Results: The mean (SD) age was 105.85 (20.23) months at first visit with mean (SD) disease duration being 15 (6.4) months. Twenty-six participants had oligoarthritic (56.5%), while the rest had polyarthritis (43.4%). Most of the patients had borderline raised TG and LDL-C (cases with raised TG n=14 (30.4%), 12 (31.5%), 5 (27.7%) at 1st visit, 3 months, and 6 months respectively and LDL-C n=12 (26%), 10 (26.3%), 6 (33.3%) at 1stvisit, 3 months, and 6 months respectively). HDL-C level was low in 36 (78.2%) cases at first visit, 28 cases (73.6%) at 3 months and 12 cases (66.6%) at 6 months respectively. Lipid profile was significantly affected by gender difference, duration of disease and drug therapy (p<0.05). Significant association have been found between JADAS score and TGL level with p value 0.03.Conclusions: Children with JIA definitely suffer from dyslipidemia. Among the biomarkers of lipid profile, low level of HDL-C is one of the most important highlights of our study. Further studies can help to strengthen the findings and formulate necessary interventions at an early stage.

Study of clinical profile of acute respiratory distress syndrome in pneumonia and outcome in intensive care unit

Background: ARDS is a progressive inflammatory lung injury in patients with hypoxemic respiratory failure. Aspiration pneumonia and pneumonia are the most common cause of ARDS in direct lung injury whereas sepsis is the most common cause of ARDS in Indirect lung injury. Methods: This was observational study conducted in Intensive care unit, Department of Medicine, CPR Hospital, Kolhapur, Maharashtra for 6 months from 1 June to 30 November 2023 in 41 patients. Results: Most common cause of ARDS secondary to pneumonia, in this study population is bacterial pneumonia, followed by viral and parasitic infections. Average day of hospital stay for bacterial pneumonia is 13 days and 11 and 10 days for viral and parasitic infections respectively. For bacterial pneumonia mortality was 36%, for viral pneumonia was 37% and parasitic pneumonia was 33.33%. Out of 41 patients,16 patients were in mild ARDS with the SOFA score range of 2 to 5 and 12 patients were in moderate ARDS with SOFA score range of 6 to 9 and 12 patients were in severe ARDS with SOFA score range of 12 to 14. Conclusions: With our study we would like to conclude that sofa score is a good predictor of mortality in c/o ARDS patients in ICU setting. Patients who had sofa score of equal or more than 9 and who were in the category of moderate to severe ARDS, had poorer outcomes and high mortality rate.

Impact of age on perioperative outcome in patients scheduled for lower limb trauma surgery under central neuraxial blockade

Background: The aim of the study was to compare perioperative outcomes between young and elderly trauma patients scheduled for lower limb corrective surgeries in our hospital under central neuraxial blockade. Methods: The study was conducted in Max Superspeciality Hospital, Mohali for a period of 1 year, November 2017 to November 2018 after approval from the Institutional Ethics Committee and review board and written informed consent from the patients. Sixty patients having American Society of Anesthesiologists (ASA) I-III physical status scheduled to undergo lower limb trauma surgery were divided into 2 groups as ‘young’ (?65 years, group Y) or ‘elderly’ (?65 years, group E). Results: The mean age of patients in group Y was 39.67±12.73 years while the mean age of patients in group E was 74.37±6.13 years. The post-operative pain score i.e. visual analogue scores (VAS) were lower inpatients in group Y as compared to group E. This difference in pain scores was found to be statistically significant especially from 8th hour onwards. Injury severity score (ISS) and pre-existing comorbidities [hypertension, renal failure and coronary artery disease (CAD)] were significant risk factors for mortality in group E patients. Conclusions: The elderly are more likely to develop adverse perioperative outcomes and are relatively less able to recover from the same.

Association between pre-operative high sensitive C-reactive protein and immediate post-operative radicular pain following prolapsed lumbar intervertebral disc surgery

Background: Nerve root compression is often inadequately understanding radicular pain due to prolapsed lumbar intervertebral disc, a common neurosurgical presentation. Inflammation is proved as an important etio-pathological component of radiculopathy, even after surgery. Methods: This cross-sectional intervention study conducted from March 2022 to September 2023. Data collected from 45 patients with prolapsed lumber intervertebral Disc, who underwent surgical intervention in Department of Neurosurgery, BSMMU. Results: The mean±SD age of the patients was 38.4±11.6 years, most of them 37 (82.2%) aged within 29 to 60 years. Majority 30 (66.7%) of them were male. Patients presented with pain, numbness and weakness was 45 (100%), 33 (73.3%) and 8 (17.8%) respectively. Among the participants most 36 (80%) had right sided and 9 (20%) had left sided radiation. The mean±SD level of pre-operative high sensitive C-reactive protein was 2.1±1.7. Pre-operative high sensitive C-reactive protein was significantly associated pre-operative, post-operative and mean change in visual analogue score (p<0.001, p<0.001, p= 0.006 respectively). Correlation of high sensitive C-reactive protein and VAS score (both pre and post-operative) were also statistically significant with p =0.017 and p <0.001 respectively. Conclusions: In our study, there is an association between pre-operative serum high sensitive C- reactive protein and post-operative radicular pain following surgical intervention in patients with prolapsed lumbar intervertebral disc.

Escala Eagle para riesgo cardiovascular prequirúrgico en endarterectomía de arteria carótida interna / Eagle score presurgical cardiovascular risk in endarterectomy of the internal carotid artery

Resumen Introducción: La endarterectomía carotídea se emplea para el tratamiento de pacientes con estenosis severa (> 70 %) o síntomas cerebrovasculares por enfermedad de la carótida interna. La escala Eagle ha sido usada como predictor de eventos cardiacos luego de una cirugía mayor. Este estudio busca determinar el uso de la escala Eagle como predictor de eventos mayores luego de endarterectomía carotídea. Materiales y métodos: En este estudio observacional retrospectivo de corte transversal, se revisaron historias clínicas de pacientes sometidos a endarterectomía carótida entre los años 2017 y 2021, donde la escala Eagle se realizó durante la visita prequirúrgica, para evaluar el riesgo de complicaciones mayores luego de una endarterectomía carotídea hasta finalizar la hospitalización. Discusión: Un total de 19 pacientes fueron evaluados prequirúrgicamente con el puntaje de la escala de Eagle y fueron tratados con endarterectomía carotídea, con un promedio de edad de 77 años. El procedimiento quirúrgico se realizó con mayor frecuencia en pacientes sintomáticos (89,40 %), incluyendo 10 (59 %) con antecedentes de ataque isquémico transitorio (AIT) y 7 (41 %) con ataque cerebrovascular. Las imágenes diagnósticas indicaron estenosis severa de la arteria carótida en 18 pacientes (94,7 %) y la mayoría de los pacientes presentaron riesgo moderado (68,42 %) según la escala Eagle, además, 5 presentaron complicaciones menores y ninguno presentó complicaciones mayores. Conclusiones: Un puntaje moderado en la escala de Eagle indica riesgo de desarrollar complicaciones cardiovasculares menores luego de endarterectomía carotídea, pero se requieren estudios con mayor tamaño de muestra para dilucidar el papel del puntaje Eagle como predictor de complicaciones cardiovasculares mayores luego de una endarterectomía carotídea.

Abstract Introduction: Carotid endarterectomy is used for treating patients with severe stenosis (>70%) or cerebrovascular symptoms secondary to internal carotid disease. Eagle score has been used as a predictor of cardiovascular events after major surgery. This study aims to assess the use of Eagle Score as a predictor of major cardiovascular events after carotid endarterectomy. Materials and methods: A retrospective observational cross-sectional study was conducted. Medical records of patients who underwent carotid endarterectomy between 2017 and 2021 were reviewed. The EAGLE scale was performed pre-surgically to assess the risk of the risk of major complications after carotid endarterectomy from surgery to the last day of hospitalization. Discussion: A total of 19 patients were assessed pre-surgically using the Eagle scale score and subsequently underwent carotid endarterectomy (Mean age of 77 years-old). The surgical procedure was predominantly performed on symptomatic patients (89.4%), including 10 patients (59%) with a history of transient ischemic attack (TIA) and 7 patients (41%) with a cerebrovascular attack. Previous diagnostic imaging indicated severe carotid artery stenosis in 18 patients (94.7%). According to the EAGLE Scale, the majority presented a moderate risk (68.42%), among whom 5 patients experienced minor complications, and none experienced major complications. Conclusions: Patients with minor cardiovascular complications after carotid endarterectomy were most commonly adjudicated as moderate risk according to the Eagle score. Further studies with large sample sizes are required to elucidate the role of Eagle Score as predictor of major cardiovascular events after carotid endarterectomy.

Efeitos de Longo Prazo do Implante Valvar Pulmonar e Evolução da Prótese em Pacientes com Tetralogia de Fallot Corrigida / Long-Term Effects of Pulmonary Valve Implantation and Prosthesis Evolution in Patients with Repaired Tetralogy of Fallot

Resumo Fundamento A regurgitação valvar pulmonar é uma importante complicação de longo prazo em pacientes com tetralogia de Fallot (TF). Objetivo O presente estudo tem como objetivo investigar os efeitos do implante valvar pulmonar (IVP) na anatomia e função do ventrículo direito (VD) e na evolução em longo prazo da prótese implantada em posição pulmonar. Métodos Uma análise de coorte retrospectiva e unicêntrica foi realizada em 56 pacientes consecutivos com TF submetidos a IVP. O estudo incluiu pacientes de ambos os gêneros, com idade ≥ 12 anos e compreendeu avaliação de dados clínicos e cirúrgicos, ressonância magnética cardiovascular pré e pós-operatória e dados ecocardiográficos obtidos mais de 1 ano após IVP. Resultados Após o IVP, houve uma diminuição significativa do volume sistólico final do VD indexado pela área de superfície corpórea (ASC), de 89 mL/ASC para 69 mL/ASC (p < 0,001) e do volume diastólico final indexado do VD, de 157 mL/ASC para 116 mL/ASC (p < 0,001). Além disso, houve aumento da fração de ejeção corrigida do VD [ FEVDc = fluxo pulmonar ajustado (fluxo pulmonar anterógrado − fluxo regurgitante) / volume diastólico final do VD ] de 23% para 35% (p < 0,001) e da fração de ejeção do ventrículo esquerdo de 58% para 60% (p = 0,008). No entanto, foi observado um aumento progressivo no gradiente de pico da válvula pulmonar ao longo do tempo, com 25% dos pacientes apresentando um gradiente superior a 60 mmHg. Próteses menores (tamanhos 19 a 23) foram associadas a um risco 4,3 vezes maior de gradiente > 60 mmHg em comparação com próteses maiores (tamanhos 25 a 27; p = 0,029; intervalo de confiança: 1,18 a 17,8). Conclusão Conforme esperado, o IVP demonstrou melhorias nos volumes e na função do VD. O acompanhamento e a vigilância a longo prazo são cruciais para avaliar a durabilidade da prótese e detectar potenciais complicações. O dimensionamento adequado das próteses é essencial para melhorar a longevidade da prótese.

Abstract Background Pulmonary valve regurgitation is a significant long-term complication in patients with tetralogy of Fallot (TOF). Objective This study aims to investigate the effects of pulmonary valve implantation (PVI) on the anatomy and function of the right ventricle (RV) and the long-term evolution of the implanted prosthesis in the pulmonary position. Methods A single-center retrospective cohort analysis was performed in 56 consecutive patients with TOF who underwent PVI. The study included patients of both sexes, aged ≥ 12 years, and involved assessing clinical and surgical data, pre- and post-operative cardiovascular magnetic resonance imaging, and echocardiogram data more than 1 year after PVI. Results After PVI, there was a significant decrease in RV end-systolic volume indexed by body surface area (BSA), from 89 mL/BSA to 69 mL/BSA (p < 0.001) and indexed RV end-diastolic volume, from 157 mL/BSA to 116 mL/BSA (p < 0.001). Moreover, there was an increase in corrected RV ejection fraction [ RVEFC = net pulmonary flow (pulmonary forward flow − regurgitant flow) / R V end-diastolic volume] from 23% to 35% (p < 0.001) and left ventricular ejection fraction from 58% to 60% (p = 0.008). However, a progressive increase in the peak pulmonary valve gradient was observed over time, with 25% of patients experiencing a gradient exceeding 60 mmHg. Smaller prostheses (sizes 19 to 23) were associated with a 4.3-fold higher risk of a gradient > 60 mmHg compared to larger prostheses (sizes 25 to 27; p = 0.029; confidence interval: 1.18 to 17.8). Conclusion As expected, PVI demonstrated improvements in RV volumes and function. Long-term follow-up and surveillance are crucial for assessing the durability of the prosthesis and detecting potential complications. Proper sizing of prostheses is essential for improved prosthesis longevity.

Evaluación de la cervicometría e índice de bishop para diagnóstico de amenaza de parto prematuro. Servicio de alto riesgo obstétrico. Hospital de la Mujer, enero ­ marzo de 2019 / Assessment of cervicometry and bishop score for the diagnosis of threatened preterm labor. High-risk obstetric service. Hospital de la Mujer, january­march 2019

OBJETIVO: determinar la validez y fiabilidad de la cervicometría y el índice de Bishop para diagnóstico de amenaza de parto prematuro MATERIAL Y MÉTODOS: estudio retrospectivo, cuantitativo, analítico para validación de un test diagnóstico. MUESTRA: el estudio incluye 185 embarazadas con feto único, de 22 a 37 semanas con estudio de cervicometría, en el periodo de enero a marzo del 2019. RESULTADOS: la frecuencia de parto prematuro en gestantes con diagnóstico de amenaza de parto prematuro fue de 27 % con mayor prevalencia en mujeres con 4 o más partos. La evaluación de la cervicometría para diagnóstico de amenaza de parto prematuro tiene una sensibilidad de 66.0%, especificidad 94.8%, Valor Predictivo (+) 82.5%, y Valor Predictivo (-) 88.3%. La evaluación del índice de Bishop una sensibilidad de 4.0%, especificidad 99.3%, Valor Predictivo (+) 66.7% y Valor Predictivo (-) 73.6%. El índice de concordancia entre la cervicometría y el índice de Bishop es ínfima de 0.017. El área bajo la curva ROC para cervicometría en relación con el diagnóstico final de parto prematuro fue de 0.905, con un mejor punto de corte 30.5 mm que corresponde a una sensibilidad de 90.4 % y una especificidad de 78.0 %. CONCLUSIÓN: se concluye que la concordancia entre la cervicometría y el índice de Bishop para diagnóstico de amenaza de parto prematuro es ínfima

In this study, the researchers aimed to determine the validity and reliability of cervicometry and the Bishop score for diagnosing threatened preterm labor in the high-risk obstetric service at the Hospital de la Mujer in La Paz during the period from January to March 2019. The study included pregnant women, and the results showed varying sensitivities and specificities for cervicometry and the Bishop score. The concordance between these two methods was found to be minimal. OBJECTIVE: to determine the validity and reliability of cervicometry and the Bishop score to diagnose threatened preterm labor. MATERIAL AND METHODS: retrospective, quantitative, and analytical study to validate a diagnostic test. SAMPLE: the study included 185 pregnant women with a single fetus, at gestational ages between 22 and 37 weeks, who underwent cervicometry assessment during the period from January to March 2019. RESULTS: the frequency of preterm labor in pregnant women diagnosed with threatened preterm labor was 27%, with higher prevalence in women with 4 or more previous deliveries. Cervicometry evaluation to diagnose threatened preterm labor showed a sensitivity of 66.0%, specificity of 94.8%, positive predictive value (+) of 82.5%, and negative predictive value (-) of 88.3%. Bishop score evaluation had a sensitivity of 4.0%, a specificity of 99.3%, a positive predictive value (+) of 66.7%, and a negative predictive value (-) of 73.6%. The concordance index between cervicometry and the Bishop score was minimal (0.017). The area under the ROC curve for cervicometry in relation to the final diagnosis of preterm labor was 0.905, with an optimal cutoff point of 30.5 mm, corresponding to a sensitivity of 90.4% and specificity of 78.0%. CONCLUSION: the concordance between cervicometry and the Bishop score to diagnose threatened preterm labor is minimal

Comparison of stent-related symptoms, passive ureter dilatation and stone clearance rate using 4.5 French versus 6 French double J stenting of unfavourable ureter: a prospective randomized controlled trial in a tertiary care centre

Background: Retrograde intrarenal surgery (RIRS) is the standard of care for renal stones of less than 1.5 cm and less than 1000 Hounsfield units (HU). Most virgin ureters do not allow the flexible ureteroscope in the first setting. Placement of a D-J stent in the ureter dilates the ureter. Therefore, our study aimed to compare stone clearance rates and symptom complex of passive ureteral dilation following 4.5 French/Fr versus 6 French/Fr double J (DJ) stent placement. Methods: After obtaining ethics approval and written informed consent, 100 patients satisfying the inclusion and exclusion criteria were included and data recorded. patients were randomized into group A (4.5 Fr) and group B (6 Fr). Stent was placed. After 4 weeks, symptoms were assessed by the ureteral stent symptom questionnaire (USSQ). Following retrograde intrarenal surgery (RIRS) successful passage of ureteric access sheath (UAS) and stone clearance rates were assessed. Results: The surgical success rate, stone clearance rate was similar in the two groups (p value: more than 0.05). The USSQ score was significantly lower in group A (p value: 0.001). Conclusions: Stent of smaller diameter (4.5 Fr) is associated with less patient discomfort with similar surgical completion rates and stone clearance.

A study of genital pruritus in female patients attending the dermatology OPD at a tertiary care center in South Rajasthan

Background: Genital pruritus is a common complaint among women, the cause of which could be multitude. Identification of these causes can lead to prompt resolution of pruritus with appropriate therapies. The objective of our study was to determine the clinical profile of genital pruritus and its impact on quality of life amongst all female patients attending Dermatology OPD at our tertiary care centre. Methods: An observational, descriptive, cross-sectional study conducted from June 2020-May 2021on 196 female patients attending the dermatology OPD with primary complaints of genital pruritus. Diagnosis was established by history and clinical examination and confirmed by bed side tests and laboratory investigations as and when required. Results: The mean age of the patients was 36.87�.24 years with 41.8% in the age group of 18-35 years. In majority (47.4%) of patients, itch was of moderate severity according to the Numerical rating scale. Infectious diseases (45.9%) were the most common cause followed by inflammatory (33.2%), idiopathic (19.4%) and hormonal (1.5%). Vulvovaginal candidiasis was by far the commonest (36.2%). The most common inflammatory dermatoses were lichen simplex chronicus (12.2%) followed by lichen sclerosus atrophicus (10.2%) and contact dermatitis (6.1%). 7 patients with idiopathic itch were diagnosed to have an underlying psychiatric illness. Conclusions: As genital pruritus has multiple causes, proper categorization and diagnostic evaluation would be appropriate to achieve optimal treatment to meet the diverse needs of women who suffer from it.

Comparison of non-invasive scores predictive of development of metabolic dysfunction associated liver disease in patients of type 2 diabetes mellitus and evaluation of additive effect of smoking in these patients

Background: Metabolic dysfunction associated liver disease (MASLD) has been found to be at alarming increase in Indian population. Prevalence of metabolic syndrome including Type 2 Diabetes Mellitus is also increasing which may be attributed to certain lifestyle changes. In the present study, we compared the likelihood of liver fibrosis by measurement of non-invasive scores among Type 2 diabetics and smokers, Type 2 diabetics but non-smokers and healthy controls. Our study will provide useful insights to evaluate the association between Type 2 diabetes, smoking and development of MASLD. Methods: The study was done at a tertiary care hospital. Participants were divided into 3 groups (each of 40 participants) which included those with type 2 diabetes mellitus and smokers, those with type 2 diabetes mellitus but non-smokers and healthy controls. Parameters included in the database were age, sex, body mass index, history of diabetes, history of hypertension, any medication, tobacco use and alcohol consumption. Venous blood samples were taken in the morning after a 12-h overnight fasting and investigations were done. Results were recorded. Results: FIB-4 score and AST/ALT ratio was significantly higher in diabetics and smoker patients, in comparison to diabetics but non-smokers and healthy controls. Conclusions: Smoking and underlying type 2 diabetes mellitus have a synergistic effect on the severity of fibrosis, as compared to nonsmokers with type 2 diabetes mellitus. Hence smoking cessation, in addition to glycemic control with regular medication, may be beneficial in reducing the severity of MASLD among patients with type 2 diabetes mellitus.

Comparative study of diclofenac, paracetamol infusion, or a combination in post-caesarean patients for pain management

Background: The World Health Organization (WHO) has released fresh information showing that the number of caesarean sections performed worldwide has increased and now accounts for more than one in five (21%) deliveries. 89.8% of women experienced significant post-operative discomfort following a caesarean section and 84.2% reported to have moderate to severe pain. This study aimed to compare diclofenac, paracetamol infusion, and a combination of both in patients of post-caesarean for pain management.Methods: The study was a cross-sectional study carried out in the department of obstetrics and gynaecology at a tertiary care hospital in a rural area of Panipat, Haryana. A total number of 102 women who underwent caesarean section were taken for the study. They were divided into 3 groups each having 34 women. The first group was given diclofenac, the second was given paracetamol infusion and the third was given a combination of both for pain management.Results: In our study we have done visual analog score (VAS) scoring at 0, 1, 6, 12, 18 and 24 hours and we found that the mean VAS score in group 3 was highest when compared to other two groups. We also found that on comparing data of VAS score between the three groups the p value came out to significant that is p?0.001.Conclusions: We found that combination therapy had good results in comparison to individual therapy and had fewer side effects.

A cross-sectional study to evaluate uploader-based quality and reliability of content on YouTube about endometriosis

Background: Endometriosis is characterized by the development and presence of endometrial glands and stroma outside of the uterine cavity. Reflux of endometrial tissue fragments, cells, and protein-rich fluid into the pelvis during menstruation is considered the most important mechanism for the development of endometriosis, which is termed reflux menstruation. This study aims to assess quality and reliability of information on YouTube related to endometriosis.Methods: A cross-sectional observational study of YouTube videos was conducted in April 2023. Videos related to endometriosis were searched by six authors, easy using one search term. Relevant videos in English or Hindi language of duration 1-20 minutes were included in the study. These were evaluated for type of uploader, popularity, type of content and lastly quality and reliability using global quality score (GQS) and DISCERN scores respectively.Results: The 67 relevant videos conveying Endometriosis related information had 21,620,808 views, 120,830 likes and 11,655 comments. Around 31 (46.3%) of videos uploaded were by doctors and health care organizations, outnumbering those uploaded by news channels 14 (20.9%), patients 5 (7.5%), and others 17 (25.4%). 59 (88.06%) of these videos described symptoms of endometriosis, and 67.1% presented the cause or etiology. A total of 47 (70.1%) of videos discussed information regarding treatment options.Conclusions: YouTube videos have a wide reach among audience. In this study it was found that there was no significant difference in the quality, reliability or video power index (VPI) of videos uploaded by different types of uploaders. It is important to ensure that content with high quality and reliability is available from qualified medical professionals and organizations; for viewers to understand their disease and take treatment decisions.

Assessing the Effect of Portulaca oleracea Seed Extract for Alleviating Collagen Type-II Induced Arthritis in Female Wistar Rat

Rheumatoid arthritis is a sign of progressive degradation of cartilage, subchondral bone, and small joints, as well as the persistence of synovitis and the formation of pannus. This research intends to assess the purported anti-arthritic effects of an extract from the seeds of Portulaca oleracea. Female Wistar albino rats (140–200 g) were used and assigned to five groups: Group I administrated NS (10 ml/kg), Group II received 0.2 ml of CoII-IFA, Group III received 300 mg/kg of fish oil, and Groups IV & V administrated 100 and 200 mg/kg of methanolic extract of Portulaca oleracea (MePO). During the experiment, the rats' weight, arthritic score, and footpad oedema were evaluated to determine the severity of their arthritis. Later, blood samples were collected from the animals, which were then analysed for haematological, pro-inflammatory, antioxidant, and histological parameters. A dose-dependent reduction was seen in rats treated with a methanolic extract of Portulaca seeds. Levels of haematological and pro-inflammatory cytokines were considerably reduced by treatment. Although both the standard drug and 200 mg/kg of MePO had anti-inflammatory effects, the latter's were more pronounced at this dose. When looking at the two side by side, results showed that the treatment groups of RBC, WBC, NL-ratio, and ML-ratio levels were normalised. Further histology confirmed the reduction of joint deformity, oedema, formation of pannus, and infiltration of neutrophils in the MePO groups in contrast to arthritic rats. It is hypothesised that Portulaca oleracea may reduce the arthritis and can be used as an adjuvant therapy or incorporate it into your diet with the main course of treatment.

LATCH score: a tool for identification and correction of breastfeeding problems in a tertiary care hospital of North Karnataka

Background: Breastfeeding, a vital childhood intervention, faces challenges despite being a natural process. Factors such as maternal confidence, latching issues, breast pain, perceived milk insufficiency, and inadequate encouragement contribute to early discontinuation. Assessing breastfeeding in postpartum mothers prior to discharge is important for successful breastfeeding. The LATCH charting system designed by Jensen et al was used to assess the score. Objectives were to determine early breastfeeding problems using LATCH score and to study the impact of breastfeeding supportive measures on LATCH score.Methods: Hospital-based prospective observational study was conducted among 100 mothers who delivered in hospitals attached to Mahadevappa Rampure Medical College, Kalaburagi. The LATCH score was assessed twice, first within 24 hrs after birth and second 48 hrs after intervention.Results: Good LATCH score was found among the rural mothers, multiparous mothers and those who had a normal vaginal delivery. After providing breastfeeding support, a majority (81%) of the mothers transitioned from poor or moderate to a good LATCH score group. The overall mean LATCH score increased from 5.83�64 to 9.31�5 following intervention. Improvement was seen in all the individual components of LATCH.Conclusions: This LATCH assessment tool can identify mothers and infants who are at risk of early breastfeeding cessation and serve as a guide to initiate appropriate intervention.