Effect of Household Air Pollution on Blood Pressure – A Review.

High blood pressure (BP) remains a public health issue of concern in low- and middle-income countries (LMICs). Cooking with solid biomass fuel is common in LMICs, producing hazardous levels of household air pollution (HAP), and exposure to which results in significant morbidity and mortality. The primary victims are women, who are the immediate users. Therefore, a potential relationship between these factors would have massive public health reverberations. Our objective was thus to perform a literature review of the studies investigating the association between HAP and BP in women. We searched the PubMed, CORE, and Semantic Scholar databases from inception through March 2022 to identify reports investigating the relationship between BP and HAP from solid fuel use. The studies included in this report point to an increased risk of high BP from HAP generated as a consequence of using solid fuels for cooking. Conversely, few studies have reported a negative association between HAP and BP. Notably, this inconsistency and the limited evidence base necessitate confirmation of the association by more extensive and robust studies. Further, this report identifies a need to introduce and implement effective clean cooking solutions for public health benefits.

An evaluation of awareness about medication error among paramedical staff working at tertiary care hospital

Background: Medication error is most common medical error and which is also under-reported particularly in developing countries. It can cause serious harm to the patients in several settings, particularly in hospitals. Aim and Objective: The aim of the study was to bring awareness among paramedical staff about medication error and to encourage them to report medication. Materials and Methods: This was a questionnaire-based-cross sectional study conducted over 6 months of duration in tertiary care hospital in 100 paramedical staff. Results: Out of 100 participants, majority of them (91%) knows about term medication error. Only 26% participants know how to report medication error in our hospital. Three-fourth (75%) do not know where to report, while 22% believes that it is professional obligation to report medication error. The majority of participants 88% agree that proper communication between health-care professionals minimizes medication error. About 77% participants believe that there is a need of independent body/committee for medication error in hospital. About 87% participants recommended training or CME about medication error in health-care professionals. Conclusion: The majority of participants had basic knowledge about medication error but lacuna on the reporting of medication error was noted. Continued medication education among paramedical staff may improver reporting.

Study Of Maternal Near Miss Events At The Tertiary Care Hospital

Background:A maternal near miss case is defined as a “a woman who nearly died but survived a complication that occurred during pregnancy,child birth or within 42 days of termination of pregnancy”1.MMR is defined as ratio of number of maternal deaths per 1000 live births. All pregnant women deserve a good quality of care especially Emergency Obstetric Care including proper infrastructure, human resources that can detect and manage such complications earliest. The objective of this study was to evaluate the causes of maternal near miss cases, various management modalities performed and maternal and fetal outcome in near miss cases. Material And Methods:A retrospective study was carried out in obstetrics and gynaecology department of SCL municipal general hospital, Ahmedabad for identification of MNM as per MNM-R operational guidelines (2014) in a tertiary care hospital from August 2020 to March 2022. Result:Total deliveries during our study period were 9266 out of which 535 number of patients developed complications, 75 patients ended up becoming near miss cases and 30 maternal mortalities were observed.Hypertensive disorders (38.6%) followed by severe anemia (18.6%) and haemorrhage (13.3%) were the commonest underlying causes leading to MNM. More than one management modality was followed in one case. 25% of patients required blood transfusion. Out of which 11 patients required massive blood transfusion (>5 units of blood) and 16% of patients required blood products along with blood resulting from either severe anemia or altered coagulopathy (DIC). 69.3% of patients required ICU stay of <5 days and majority of patients required hospital stay of 9-14 days.63.6% of patients required ICU stay of 1-4 days.Live birth rate was 82.6%.Conclusion:Maternal health is the direct indicator of prevailing health status in a country. Reduction in maternal mortality is one of the targets of MILLENIUM DEVELOPMENT GOALS13for 2015 but in spite of full efforts by all the health care professionals, it still remains a challenge in developing countries.There should be prompt and proper management of high-risk groups by frequent antenatal visits. Aggressive management of each complication and close monitoring of women in labour, decision making in mode and time of termination of pregnancy are important to prevent further complications.

Coverage Of Multiple Maxillary Gingival Recessions Using Coronally Advanced Flap With Subepithelial Connective Tissue Graft: A Case Report

Background:This case report describes treatment of multiple gingival recession with subgingival connective tissue graft and coronally advanced flap technique in treatment of maxillary teeth. Material And Methods:Connective tissue grafting wasdone in relation to upper right second premolar, first premolar, canine, right central incisor, left central incisor and left lateral incisor (#15,#14,#13,#11,#21,#22). A split thickness flap was elevated without disturbing periosteum in this region. The area between canine and second premolar was selected to harvest the graft. The graft was placed on the recipient bed and suturing was done. Result:Predictable root surface coverage could be obtained with use of coronally advanced flap and subepithelial connective tissue graft. Conclusion:Subepithelial connective tissue graft along with coronally advanced flap still stand as a gold standard treatment for gingival recession coverage.

Drug utilization study in ophthalmology outpatient department of a tertiary care teaching hospital

Background: Drug utilization studies (DUS) provide insight into recent trend of drug usage and facilitate rationality of prescribed drugs. Few DUS have been conducted in ophthalmology. Aim and Objective: To analyse the prescription pattern in outpatients of the ophthalmology department at a tertiary care teaching hospital. Materials and Methods: A prospective, observational and cross-sectional study was conducted at GCS Medical College Hospital and Research Centre, Ahmedabad. All patients who visited ophthalmic outpatient department were enrolled and necessary data were recorded regarding drugs prescribed in pre-defined case record form. Data analysis was carried out using Microsoft Excel. Results: A total of 388 prescriptions were analysed. Average number of drugs and fixed-dose combinations (FDCs) per prescription were 2.47 (95% CI, 2.29–2.64) and 0.44 (95% CI, 0.36–0.51), respectively. Drugs were prescribed in different dosage forms with eye drops being the most common (95.1%) followed by tablet (12.3%), ointments (8.5%), capsules (2.8%), syrup (1.1%), and injections (0.3%). One or more dosage forms were seen per prescription. Total 957 drugs were prescribed, out of which drugs with brands name and generic name were 88.4% and 11.6%, respectively. Total FDCs prescribed were 17.5%. Overall, 43.5% of prescriptions had antibiotics ranging from 1 to 5 per prescription and 25% of antibiotics were seen out of total drugs. Conclusion: Most of the drugs prescribed were in the form of drops. FDCs and antimicrobial use have been increasing in the management of ophthalmic diseases. Less numbers of drugs were prescribed by generic names.

Conceptual And Applied Aspect Of Agnikarma In The Purview Of Cauterization

In Ayurveda, Shalyatantra is one of the eminent branches based on six major methods of management among which Agnikarma is boon for local Vata and Kaphaja Vyadhi. Its effect can be assessed as Sthanik Karma (local action), Saarvadaihik Karma (Action throughout the body) and Vishista Karma (Special actions). Based on amount of Agni needed, the condition and site of disease, Dahanupakarana are used to produce therapeutic burns during Agnikarma Chikitsa. It can be classified according to Dravya used, site, disease, Akritiand Dhatu to be cauterized. Based on the Dagdha (Burn), it is again of four type viz. scorched burn, blistered burn, superficial burn and deep burn. Its indication is in all seasons except in summer and autumn. Indications and contraindications are well expounded in classics with detail information on Purva Karma, Pradhana Karma and Paschat Karma during Agnikarma as it is superior to every other procedure used in Ayurveda Surgery. In modern medicine, there is no use of therapeutical burn i.e., Samyak Dagdha Chikitsa but its use is in other form eg., Cauterization is used for coagulation and tissue destruction. Agnikarma is considered as the best therapy to pacify Kaphanubandha Vata Dosha because Agni possesses Ushna, Tikshna, Sukshma, Aashukari Gunas, which have anti Vataja and anti Kaphaja properties. It is done by red hot Shalaka. It gives quick relief to the patient and hence is termed as best therapy.

Current concepts in crosslinking thin corneas

Corneal cross-linking (CXL), introduced by Wollensak et al. in 2003, is a minimally invasive procedure to halt the progression of keratoconus. Conventional CXL is recommended in eyes with corneal thickness of at least 400 microns after de-epithelialization to prevent endothelial toxicity. However, most of the keratoconic corneas requiring CXL may not fulfill this preoperative inclusion criterion. Moderate-to-advanced cases are often found to have a pachymetry less than this threshold. There are various modifications to the conventional method to circumvent this issue of CXL thin corneas while avoiding the possible complications. This review is an update on the modifications of conventional CXL for thin corneas.

Management of Candida glabrata infectious crystalline keratopathy with endophthalmitis following penetrating keratoplasty

A 33-year-old male underwent an optical keratoplasty elsewhere in the right eye following which he developed endophthalmitis and subsequently underwent a pars plana vitrectomy and lensectomy. At presentation, he had a deep stromal crystalline infiltration along the graft–host junction. A large therapeutic keratoplasty was performed, and the excised corneal button was evaluated. Histopathology revealed gram-positive round-to-oval budding structures and microbiology identified the organism as Candida glabrata. He was treated with antifungals in the postoperative period. At 4 months after therapeutic keratoplasty, the patient developed recurrent endophthalmitis, following stoppage of antifungals. The treatment was reinstituted for another year, and the patient did well with a clear graft at 18-month-follow-up period after the recurrence episode. Management of infectious crystalline keratopathy with endophthalmitis is a challenging situation and requires long-term treatment.

Assessment of the rotator cuff on MRI focussed on supraspinatus tendon

Background: Shoulder pain is the third most common musculo-skeletal complaint after low back pain and knee pain. The most common cause of shoulder pain is rotator cuff disease. For the evaluation of shoulder joint, MRI is the modality of choice and is considered over USG. MR imaging is the global assessment of all shoulder structures. Materials and methods: A prospective study of 65 patients were conducted, who were referred to the Department of Radiodiagnosis, Dhiraj General Hospital with shoulder pain. All the scans were done on Philps MR systems Achieva 1.5 tesla. T1 and T2 weighted images in the sagittal, coronal, axial planes were obtained in each patient. Results: In a retrospective review, 50 patients referred to our institution for diagnostic workup for shoulder complaints from June 2016 to December 2016. Out of these, only 7 had no visible pathology. Rotator cuff tendinopathy accounts maximum in which supraspinatus tendinopathy was found in 60% cases (26 patients), subscapularis tendinopathy were in 10% (4 patients), infraspinatus tendinopathy and rotator cuff tendinopathy was not found in any patient. Rest of the pathologies included soft tissue pathology, subacromial-subdeltoid bursitis. Conclusion: MRI provides elaborate diagnosis thus it replaces other investigations. Thus MR imaging is the standard among the imaging methods for optimal depiction of almost all shoulder pathology.

Effects of CD4 count level on patterns of respiratory tract infections of HIV-infected patients in Western India.

Background: Individuals with HIV infection are at increased risk for tuberculosis (TB) and other respiratory tract infections (RTIs). The altered CD4 T-cell homeostasis induced by HIV infection may play a key role in the development of respiratory tract infections in HIV -infected patients. Aim: Finding out of mean CD4 count of HIV patients at which they were at higher risk of developing various RTI and accordingly when HAART is to be started in this part of the world. Material and methods: All the 961 HIV infected patients and 300 300 HIV sero-negative patients’ three early morning sputum were screened for routine bacterial and fungal pathogens and even examined for AFB and few of the samples were even cultured on LJ medium All sputum samples’ smears were also examined for PMNLs in Gram’s staining. Results: Out of all these 961 HIV patients, in 349 patients with probable viral RTI etiology, the mean CD4 count was found to be 474.62 + 114.89, followed by mixed polymicrobial RTI (80 patients) with mean CD4 about 392.26 + 87.14. The patients with pure fungal etiology (66), the mean CD4 count was found to be 377.29 + 268.29 followed by 466 patients with pure monomicrobial bacterial RTI the mean CD4 count was about 223.07+_83.21. Conclusion: Very vague co-relationship between pattern of RTIs and CD4 counts had been attempted. Only Fungal and Bacterial RTIs were seen first to establish in even HIV infected patients at very high mean CD4 counts of about 377 + 268.29 and 223.07 + 83.21 respectively, but in both very high prevalence rate had been observed when compared with HIV non-infected patients with probability values of <0.05 and <0.001 respectively. Probable viral etiology of RTI was significantly high in HIV-non infected subjects when compared to HIV -infected RTI patients with probability value P < 0.001.

A clinical study to assess the pathological involvement of occult supraclavicular lymphnode metastasis in case of locally advanced operable breast carcinoma.

PURPOSE: The prognosis of ipsilateral supraclavicular lymph node (SCLN) recurrence after early breast cancer appears to be worse than for other locoregional recurrences, but better than for distant metastases. Prophylactic radiotherapy (RT) to supraclavicular region decreases risk of ipsilateral SCLN recurrence. Currently, all patients with locally advanced breast cancer are considered high‑risk for SCLN metastasis and treated with prophylactic RT. This study is carried out to identify risk factors associated with occult SCLN metastases in locally advanced breast cancer. MATERIALS AND METHODS:Total 48 female patients of all ages presenting with locally advanced carcinoma of breast who were operable by protocol criteria were included in the study. All the patients underwent modified radical mastectomy with supraclavicular lymphnode dissection. The resected specimen was processed for the histopathological analysis. RESULTS: Occult SCLN metastases are found in 25% (12/48) of the patients in this study. Eleven factors were identified and analyzed to know whether or not they are associated with SCLN metastasis. Of those only pathological N stage (7% for <pN3 vs and 52% for pN3 stage) and level axillary nodal involvement (7% for patients without Level III involvement and 52% for with Level III involvement) are significantly associated with high‑risk for occult supraclavicular lymphnode metastasis. Other factors such as age, menopausal status, T stage, pathologic grade, lymphovascular invasion, extracapsular extension, hormone receptor, and Her2 neu receptor status are not associated with risk for SCLN metastasis. CONCLUSION: Our study has shown that only high axillary disease burden in terms of more than 10 node positivity or more than 75% positive node out of total dissected nodes is associated with occult supraclavicular lymphnode metastasis breast cancer.

Initial experience with hyperthermic intra peritoneal chemotherapy and cytoreductivesurgery.

BACKGROUND: Promising results were reported with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in peritoneal carcinomatosis. Experiences in India are not published. This is a preliminary report. MATERIALS AND METHODS: From eight patients with peritoneal metastasis, six patients (5 M, 1 F), aged (40‑62 years) were treated with CRS and HIPEC between May 2010 and August 2011 from a single institution. Three had Mucinous Adenocarcinoma of Appendix and one each with Mesothelioma, Ovarian Cancer and Colonic Cancer. Four were earlier treated with systemic chemotherapy and recurred. Pre‑operative peritoneal cancer index (PCI) was calculated based on recent computerized tomography or positron emission tomography scans. Surgical completeness cytoreduction score (CCS) was classified as macroscopically complete (CCS‑0); optimal residual disease ≤2.5 mm in any region (CCS‑1); or grossly incomplete: Residual disease >2.5 mm (CCS‑2) or >25 mm (CCS‑3). They were treated by closed perfusion technique with mitomycin‑C (MCC) and cisplatin at 41‑42°C, for 60 min. RESULTS: Optimal cytoreduction (residual tumor nodules <2.5 mm i.e. CC0 and CC1) was performed in four patients (66.67%). There was no operative mortality or Grade 3 and 4 toxicity. Patients with PCI <11 are alive without recurrence with overall survival of 26‑31 months. Those with PCI >11 had recurrence with overall survival of 3‑19 months. Two patients died at 3 and 9 months. CONCLUSION: CRS and HIPEC is a promising therapeutic option in selected patients with peritoneal carcinomatosis. These results in six patients are preliminary but encouraging. Patient with low PCI had better disease free survival.

A study of venous drainage of thyroid gland in 50 cadavers.

Introduction: The thyroid gland is drain by mainly three vein, superior thyroid vein, middle thyroid vein, inferior thyroid vein. Some time fourth thyroid vein of kocher is also present. Material and Methods: Anatomy of venous drainage of thyroid gland was studied in 50 formalin embalmed cadaver, aged between 60 to 80 years. Dissection method was use for this study. Result and Observation: Middle thyroid vein found to be absent in 12 cases. No abnormality found in superior thyroid vein and inferior thyroid vein. Termination of all veins was traced. Thyroid vein of kocher was not found in any cases. Conclusion: A better understanding of the anatomic variability in superior thyroid vein, middle thyroid vein and inferior thyroid vein may be useful not only to minimize the risk of bleeding, but it also can help to perform a more accurate dissection with the goal of preserving the laryngeal nerves and parathyroid glands, especially because of its location and relationships with other adjacent structures.

Relation between serum uric acid and Non Insulin Dependent Diabetes Mellitus(NIDDM).

Background & Objectives: NIDDM is an independent risk factor for cardiovascular disease. NIDDM increases the risk for all manifestations of atherosclerotic vascular disease, coronary heart disease, cerebro-vascular disease and peripheral vascular disease. Coronary heart disease mortality and morbidity rates are two to four times higher in diabetic patients than in non-diabetic subjects. NIDDM is a metabolic disorder that is characterized by high blood glucose in the context of insulin resistance and relative insulin deficiency. The aim of the study was to assess the relation between serum uric acid and NIDDM. Methods: The study group included 30 NIDDM cases and 30 control of both sex. Fasting blood samples were collected from both cases and controls in Dhiraj General Hospital, Pipariya, vadodara. Fasting blood sugar, and serum levels of uric acid, creatinine, lipid profile assayed by standard IFCC protocol. Results: There was a significant increase in fasting blood sugar, serum creatinine, uric acid, and lipid profile with exception to high density lipoprotein in NIDDM cases as compared to control. However the correlation bet ween uric acid and other parameter was not very relevant. Conclusion: The study showed significant increase in serum uric acid with the increase in blood sugar value in NIDDM. Elevated uric acid levels are associated with increased risk of cardiovascular mortality in NIDDM.

Study of lipid profile in cirrhotic patients.

Background &Objective: liver cirrhosis is a chronic inflammatory condition associated with lipid abnormalities. The aim is to study lipid profile in liver disease and to determine the lipid profile in patients with cirrhosis and to asses if it relates to the severity of the cirrhosis. Materials and Methods: In an analytical cross-sectional study, 40 patients with cirrhosis (case) and 40 age- and sex-matched healthy normolipidemic patients (control) were studied in Dhiraj General Hospital, Pipariya, and Vadodara. Details including personal characteristics, etiology of cirrhosis, and lipid profile (total, LDL, and HDL cholesterol and triglyceride) was taken for each patient (both case and control). Statistical analysis was done and results were documented. Results: In patients with cirrhosis, there was a significant decrease in serum total cholesterol, triglyceride, LDL and HDL cholesterol levels compared to the control group (mean of 132 vs. 186, 78 vs. 182, 76 vs. 137, and 41 vs. 47 mg/dL, respectively; all p<0.05). Interpretation & Conclusion: Serum total, LDL and HDL cholesterol level in patients with cirrhosis is inversely correlate with severity of cirrhosis.

A study of inter-pedicular distances of the lumbar vertebrae measured in dried vertebrae in Gujarat.

The reduced inter-pedicular distance is one of the common causes of primary narrowing of the spinal canal. Stenosis of the spinal canal due to decreased inter-pedicular distance is to the best of our knowledge, virtually unexplored so we under took this study of inter-pedicular distance. Eisestein S measured inter-pedicular distance in Caucasoid, Zulu Negroid and Sotho Negroid population which is compared with data of present study. Methods: All measurements were made by using Electronic Digital Vernier Calipers. Transverse diameter of the lumbar spinal canal was measured as the minimum distance between the medial surfaces of the pedicles of a given vertebra (Inter-pedicular distance. Results & Observation: Inter-pedicular distances of lumbar vertebral canal at levels L1 to L5 was measured in dry vertebrae of 63 subjects (32 male, 31 female) from Gujarat of age group 35 to 80 yrs. Mean transverse diameter (Inter-pedicular distance) is minimum at L1 (22.6 mm in male and 21.3 mm in female) and maximum at L5 (27.0 mm in male and 26.4 mm in female) showing a gradual increase from level L1 to L5. The inter-pedicular distance increased steadily from L1 to L5 in all populations in both sexes. The Gujarati population has greater IPDs at all level from L1 to L5 than that of Zulu Negroid and Sotho Negroid. But IPDs in Gujaratis are lower at L1, & L2 in male and L1, L2 & L3 in female and greater at L3, L4 & L5 in male and L4 & L5 in female than that of Caucasoid. Conclusions: A comparison between the present data and the data published data on inter-pedicular distance at lumbar levels of other populations also shows that there are marked differences between the mean values reported for the population of different geographic areas. The present study confirms that there is ethnic as well as racial variation in the size of the lumbar vertebral canal, thus, emphasizing the need to have normal values and ranges for the transverse diameter of the canal for different populations.

A brief review of voice restoration following total laryngectomy.

Despite advances in conservative laryngeal surgery and radiotherapy, total laryngectomy still remains the procedure of choice for advanced-stage (UICC T3 and T4) laryngeal carcinoma, around the world. The functional rehabilitation of the laryngectomized patients has been a concern of head and neck surgeons and speech therapists. Significant developments in speech rehabilitation over the past three decades have led to substantial improvements in the quality of life of these patients. The tracheoesophageal (TE) voice prosthesis has become the gold standard in various centers for voice rehabilitation since its introduction in 1980. Successful tracheoesophageal voice restoration in laryngectomy patients can be very rewarding and patients no longer have to live in silence while they await the results of their cancer treatments. They can face the challenges of life with the knowledge that a near normal quality of life is very much possible.In this article, we present a brief review of voice restoration following laryngectomy.

Anti-stress and anti-oxidant effects of roots of Chlorophytum borivilianum (Santa Pau & Fernandes).

The aqueous extract of C. borivilianum (250 mg/kg for 7 days) significantly reverted the elevated levels of plasma glucose, triglycerides, cholesterol and serum corticosterone and also reduced the ulcer index, adrenal gland weight more as effectively as the standard drug (diazepam) in rats. At 125 mg/kg po, it showed a mild anti-stress activity. Under in vitro 1,1-diphenyl-2-picrylhydrazyl (DPPH*) free radical scavenging assay and lipid peroxidation assay the extract considerably inhibited, in a dose-dependent manner, the levels of DPPH* free radicals and thiobarbituric acid reactive substances, respectively thus showing significant antioxidant property. The results suggested that it could be used for the treatment of oxidative stress-induced disorders.

Neoadjuvant chemotherapy before surgery of hepatoblastoma.

Though surgical resection is the main stay of treatment for childhood hepatoblastoma (HB), many are unsuitable for radical surgery at diagnosis due to extensive intrahepatic and/or extra hepatic disease. We report experience in five patients of HB from a single institution (2001-2005) with preoperative Neoadjuvant chemotherapy (NACT) followed by surgery. Three patients received cisplatin, doxorubicin; and two cisplatin / vincristine /5-fluorouracil. All showed more than 50% reduction in tumor size confirmed by CT scan. Hepatic resection R0 was performed in all. There was no chemotherapy related toxicity nor post surgical morbidity or mortality. All are disease free at median follow up of 4 years. NACT produces adequate down staging of the HB with acceptable toxicity. Though cisplatin with doxorubicin produced good results, new protocol with cisplatin, vincristine and 5FU is promising without cardiotoxicity.