Comparison of Demography, Resource Utilization and Outcomes of COVID 19 patients admitted during First and Second waves at a tertiary care institute in Kanyakumari, South India

Introduction: The novel Coronavirus disease 19 (COVID-19) affected India, predominantly in two time periods – the first wave from March to December 2020, and the second wave that raged from April to July 2021. Although the time duration of second wave was shorter than the first, the onslaught of the disease was much more severe during the second wave. Objective: To compare the demographic characteristics and clinical outcomes of COVID-19 patients admitted during the first and second pandemic waves. Method: Demographic characteristics, duration of hospitalization, critical unit admission, and mortality data of 137 and 345 COVID-19 positive individuals, from first and second waves respectively, were retrospectively analyzed in a teaching hospital in South India. Descriptive statistics, Independent t test, chi square tests and regression analysis were used for statistical analysis, with significance level prefixed at 5%. Results: Median age of hospitalisation was 46.2 years and 48.39 years during first and second waves respectively, with male preponderance in second wave. There was a statistically significant difference in mean duration of stay (9.04 days v/s 7.53 days), mean Spo2 at admission (98.4% v/s 96.6%), ventilation requirement (1.5% v/s 8.7%), oxygen requirement and ICU care between the two waves.Conclusion: During the second COVID wave, significantly higher hospitalisation rates, intensive care requirements and inpatient mortality was observed. Elevated C Reactive Protein levels, lymphocytopenia, history of diabetes and other co-morbidities were associated with poor outcomes in both waves.

Impact of a One?Day Three?Dimensional Transesophageal Echocardiography Workshop on Clinical Practice at a Single Academic Centre

Background:Transesophageal echocardiography (TEE) is a powerful diagnostic tool which has become an integral part in the management of cardiac surgery patients. We developed a one-day 3D TEE workshop specifically designed to meet the needs of perioperative cardiac anaesthesiologists. We hypothesized that participation in the workshop would increase the uptake of 3D TEE in routine perioperative practice. Aims: To examine the impact of one-day 3D TEE workshop on 3D TEE image acquisition and incorporation into routine perioperative practice. Setting: Tertiary care hospital. Design: Prospective observational monocentric study. Subjects and Methods: A convenience sample of 20 cardiac anesthesiologists (with an option to attend the one- day workshop midway through the study) from a single center consented to have their intraoperative TEE images collected during the course of the study reviewed for research purposes. Images acquired 6 months before, immediately after, and 6 months following the workshop and images were examined by a blinded, expert echocardiographer. Results: Data collected for 16 participants (8 workshop attendees, 8 non-attendees) indicate that the TEE workshop increased the number of 3D TEE images, but not x images acquired immediately following the workshop (P=0.006). No difference was observed in number of 3D images at six months’ post workshop. Workshop participants obtained more 3D and multi-plane images after the workshop and more 3D images at 6 months compared to those who did not attend the workshop. Conclusion: Our study suggests that a single day hands-on 3D TEE workshop may have had an impact on the implementation of intraoperative 3D TEE in experienced echocardiographers.

Sleep Quality in End Stage Renal Disease Patients Undergoing Hemodialysis in a Tertiary Care Center in Rural Kanyakumari: A Cross Sectional Study

Introduction: End Stage Renal Disease (ESRD) has increased in prevalence worldwide, becoming a major public health problem. About 80% of ESRD patients have subjective complaints of poor sleep. Poor sleep quality can potentially affect their quality of life and the pattern of medication use. Hence this study was designed to evaluate the quality of sleep in patients undergoing haemodialysis and to determine associated risk factors. Method: This cross sectional study was carried out among 110 ESRD patients in the dialysis unit of Kanyakumari hospital. Patients previously diagnosed with neuropsychiatric disorders, sleep apnoea or epilepsy were excluded. An investigator-administered structured questionnaire was used. Sleep quality was assessed using the Pittsburg Sleep Quality Index. A global PSQI score of more than 5 indicates poor sleep quality. Results:Mean age of ESRD patients was 52.7 years. About 71% of the patients were males. Majority of the patients (68.2%) had pre-existing Diabetes and Hypertension. Almost all of the patients (97.3%) had a PSQI score of more than 5 and were 'poor sleepers'. About 94.7% patients had not used sleep medications at all. Increasing age and multiple morbidity were found to be statistically significant risk factors of poor sleep quality. Conclusion: Almost all of our subjects had poor sleep quality sleep and only few of them sought treatment for the same. Early detection of poor sleep quality will help in better management of sleep disorders among ESRD patients.

Peroxisome proliferator-activated receptors and thiazolidinediones in diabetic nephropathy

Diabetic nephropathy is global problem with several drugs into trial without much success the current article highlights the role of thiazolidinedione’s in diabetic nephropathy by scrutinizing and reconnoitring the cellular and intracellular mechanism and shielding action and the role of peroxisome proliferator-activated gamma receptors (PPAR?) receptors. Not only anti-diabetic action but renal protective effect with evidence based study has been highlighted. PPAR ?-is versatile target having numerous benefits and mainly preventing fibrosis in diabetic experimental model and some clinical case report yet, the benefits are not up to mark, since renal failure itself causes volume expansion and the thiazolidinedione’s (TZDs) also preserve salt and water and lead to congestive heart failure which constraints its clinical application. Dual activators and balaglitazone selective PPAR modulator are having upcoming potential for treatment of diabetic nephropathy. Further detail investigation on such drug is needed to explore. However adverse effect like heart failure, osteoporosis and volume expansion effect over-rides the beneficial effect thus limiting its clinical use of currently available TZDs.

Knowledge, attitude, and practice of senior dental students toward management of complications in exodontia

Introduction: Dental graduates have a professional responsibility of being competent in managing the complications in exodontia, a very commonly performed procedure. Aim: The aim of this paper was to assess the knowledge, attitude, and practice of senior dental students toward the management of complications in exodontia. Materials and Methods: Four hundred dental students participated in the study voluntarily. Verbal consent was obtained after elaborating the purpose of the study. A short validated questionnaire consisting of 12 close-ended multiple choice questions was distributed to all the students. The questionnaires were collected back and results from fully filled questionnaires were tabulated in Microsoft Excel 2007. Results: Nearly 93.4% of the students perform extractions in their practice on a routine basis. Among those 32.5% of the students have encountered complications, out of which only 20% of the students are confident in managing them. The remaining 64.8% of students who have not encountered complications are not confident in managing the same. Conclusion: This study revealed the need for increase in cases which will in turn help the students to transfer their theoretical knowledge into professional skills.

Study on clinical assessment of volume status and correlation to the respiratory variation in inferior vena cava diameter by echocardiography, a non-invasive method of measuring volume status

Introduction: Giving more fluid causes edema and less gives rise to hypoperfusion causing improper delivery of oxygen and substrate leads to cellular dysfunction and multiorgan dysfunction involving the brain, liver, kidneys, heart, lungs and causing death. Diffusion, filtration, osmosis and adequate reabsorption help in continuous exchange of water and solutes among compartment. Daily water intake from the food and water get equalized with losses in the kidneys as urine, from the gastrointestinal system as feces and evaporation of water through lung and skin. Various hormones like Angiotensin II, Aldosterone ADH, Atrial natriuretic peptide maintain sodium and water balance and hence volume status. To maintain normovolemia there is every need for meticulous evaluation for patient Volume status in each patient for adequate volume replacement. Aim of the study: Correlating the Clinical Assessment of Volume Status to the volume assessment By Echocardiography using Respiratory Variation in Inferior Vena Cava Diameter. Gnanaprakasam J, Vasantha Kumar M, Praveenkumar M, Lakshmi Priya R. Study on clinical assessment of volume status and correlation to the respiratory variation in inferior vena cava diameter by echocardiography, a non-invasive method of measuring volume status. IAIM, 2018; 5(5): 104-110. Page 105 Materials and methods: Study population consisted of 200 patient of medicine department both inpatient and outpatient of Chengalpattu Medical college. The patient was examined clinically, history suggestive of volume depletion and history suggestive of volume overload were noted, signs and symptoms of both hypovolemia and hypervolemia were noted. Echocardiography was used as a noninvasive method of measuring volume status. Results: Correlation of assessment of volume status by the clinical method and IVC method as low, normal and high was represented. Correlation – 0.797, P value < 0.001 which tell that there was a statistically significant correlation between your two variables. That means, increases or decreases in IVC do significantly relate to increase or decrease. Conclusion: The use of echocardiography as a non-invasive mode of volume assessment is helpful to empower the clinical assessment methods and hence improves diagnostic accuracy.

Adrenal tumors: An experience of 10 years in a single surgical unit.

INTRODUCTION: Most of the adrenal masses are discovered incidentally by imaging techniques for reasons unrelated to adrenal diseases. Treatment is based on various factors such as, nature of adrenal mass, age of presentation, size of tumor, and the functional status of tumor. We report a series of 14 consecutive cases of adrenal tumors treated in a single surgical unit in our hospital. AIM: The aim of this study was to evaluate the clinical profile and outcome of treatment of adrenal tumors treated in a surgical unit. MATERIALS AND METHODS: It is a retrospective study data of 14 cases of adrenal tumors treated in a single surgical unit in University Hospital over 10 years have been analyzed. Various parameters such as gender, age, size of tumor, functional status, histopathology, type of management, and outcome have been reviewed. RESULTS: A total of 14 patients with adrenal masses were seen over a 10 year period (1997‑2006). All were referred cases, either from endocrinology or medicine wards. There were seven female and seven male patients. Mean age of patients was 48.6 years (range 14‑60 years). Mean size of tumor was 8.0 cm (5.9 cm for benign tumors and 9.7 cm for malignant tumors). There were six cases of adrenal carcinoma, four cases of adrenal myelolipoma, two cases of pheochromocytoma, and one each case of adrenal hyperplasia and histoplasmosis. There were only two functional tumors. All, except two malignant cases were treated operatively. A total of 5 year survival was 100% in benign cases and 27% in malignant tumors. CONCLUSION: Adrenal tumors need to be assessed for their functional status and malignant potential prior to treatment. Surgical excision is usually curative for benign lesion. Among malignant tumors the benefits of surgery depend on local extent and metastatic status of tumors.

Study of Trophoblasts and Histological Changes of Fallopian Tube in Tubal Pregnancy and Anatomical Considerations for Its Early Rupture.

Fertilisation takes place in the lumen of fallopian tube, from where, aided by the ciliated columnar epithelium of the tube, the fertilised ovum makes its way into uterine cavity and the implantation occurs. The passage of fertilised ovum into uterine cavity is delayed or obstructed by developmental, mechanical or other defects which lead to tubal gestation. The incidence varies from 1 in 300 to 1 in 150 pregnancies and it contributes significantly to the maternal mortality and morbidity. Early diagnosis and therapy has helped to reduce the maternal death due to ectopic pregnancy. However, study on histological changes of early ectopic pregnancy are rather scarce and therefore, the present study was conducted on 25 patients of ectopic pregnancy specimens observed for the mode and extent of invasion of chorionic villi, and the histological changes in wall of the fallopian tubes to evaluate the causes of early tubal rupture as well as estimation of gestational age by the study of chorionic villi.

P300: a cognitive evaluation tool in acute ischemic stroke: a narrative review

Cognition is the scientific term for mental processes. These processes include attention, memory, problem solving, making decisions, producing and understanding language. This cognitive function is altered by various conditions like brain damage, ageing etc. Stroke is one of the main cause of cognitive impairment with an incidence ranging between 12 and 56% of affected population. P 300 is a long latency endogenous evoked potential. And it is referred to as cognitive evoked potential or event related potentials. P 300 is a wave form appears about 300ms following task - related endogenous stimuli which require attention and patients cooperation. The P 300 reflects processes related to attention, decision - making and memory updating. Research design: Narrative Review. EEG apparatus, event related potential P 300 wave form. In general, exercise improves the cognitive function. Various types of subjective measures available to assess the cognitive function but there is no direct reliable measure to asses cognitive function in patients. There is a need to find the scientific way of measuring cognitive function. In this review, a neurophysiological measure P 300 is explained to measure the cognitive function improvement after physical therapy management in stroke. P 300 will be a novel way of measuring cognitive function improvement after physical therapy management in stroke

Efficacy of antenatal synergistic facilitation of pelvic floor muscles versus kegel exercises on pelvic floor muscle strength- a post-partum review

To compare the efficacy of antenatal synergistic muscles facilitation on pelvic floor versus kegels exercises on postpartum pelvic floor muscle strength. Quasi-experimental, Post-test only design with a comparison group. Department of Obstetrics and Gynecology, P. S. Govindasamy Hospitals, Coimbatore, Tamilnadu, India. Seventy-eight antenatal women were randomly selected. Among the 78 women, 39 each were assigned to Group A [interventional group] and to Group B [control group]. Finally 21 women in each group continued the treatment program. o Group A- synergistic muscles of pelvic floor [Diaphragm, Abdominals, Ankle dorsiflexors and pelvic floor muscles] o Group B - kegels exercises [Only pelvic floor muscles]. The pelvic floor muscle strength was measured using Perineometer after 30 days. Data from 42 women were analyzed. Independent t- test was used as statistical tool. A significant difference in the postpartum pelvic floor muscle strength was found between the interventional and the control group. The mean difference between the interventional and control group was 1.762mm hg. The calculated t value using independent t- test was 3.584 which was greater than tabulated test statistical value of the 1.960 at [p < 0.05]. The pelvic floor muscle strength was comparatively greater among the women who performed synergistic muscle re-education than kegels exercise group. Hence, antenatal Motor Relearning approach of diaphragmatic, deep abdominal and pelvic floor exercises can be implemented during a normal pregnancy unless precluded by additional risk factors

case report on phantom limb pain treated with mirror box therapy

To study and report the effect of mirror box therapy in the management of phantom limb pain after an upper limb amputation. Single Case study. Informal experimental. A diagnosed case of phantom limb pain of left upper limb was treated with mirror box therapy for 4 months with customized training protocols. 4 repeated assessments at the end of each month were performed using Verbal Rating Scale. The patient had notable clinical recovery following mirror box therapy for 4 months

Conductive education in the treatment of unilateral neglect: a case report

To determine whether motor learning using conductive education principles help: unilateral neglect. Descriptive case study - informal, motor relearning program based on the principles of conductive education through visual tracking was performed on a single case of a 62 year old unilateral neglect. Pre- to post-intervention outcome was measured on upper and lower limb function scale. Early intervention through conductive education helped in hastening the motor recovery in this case of unilateral neglect. Remarkable recovery was noted in the ista1 segments of the upper limbs and knee joint of lower limbs

Chemical composition and in vitro antioxidative potential of essential oil isolated from Curcuma longa L. leaves

Objective: To determine the chemical composition and antioxidant potential of essential oil isolated from the leaves of Curcuma longa (turmeric). Methods: Chemical composition of the oil was analyzed using GC-MS. Antiperoxidative potential was evaluated using linoliec acid emulsion system. Free radical scavenging activity was evaluated using stable DPPH and ABTS free radicals. Results: GC-MS analyses showed that major compound present in the turmeric leaf oil is b-sesquiphellandrene (22.8%) followed by terpinolene (9.5%). Essential oil also exhibited reductive potential and antioxidant potential in linoleic acid emulsion system along with DPPH and ABTS free radical scavenging potential. Conclusions: The overall result suggests that turmeric leaf oil is capable of retarding oxidation reaction and free radical mediated damage and can be developed as a potent natural antioxidant.

Retromolar foramen.

Of the many variants in the mandible, the retromolar foramen is the most important. The incidence of retromolar foramen was studied in a collection of 157 south Indian mandibles available at the department of Anatomy, St. John's Medical College, Bangalore. On each side of the mandible, the area behind the last molar tooth was inspected for the presence of retro molar foramen. Wherever present, their distance from the last molar tooth and their size if they were sufficiently large were measured with a sliding caliper to the nearest millimeter. Retromolar foramen were found to be bilateral in 8 mandibles (5.1%) and unilateral 20 [right: 9 (5.7%); left: 11 (7%)] mandibles. The diameter of the foramina was 2 mm on both sides.

Injection practices in a metropolis of North India: perceptions, determinants and issues of safety.

BACKGROUND: At least 50 percent of the injections administered each year are unsafe, more particularly in developing countries, posing serious health risks. An initial assessment to describe injection practices; their determinants and adverse effects can prevent injection-associated transmission of blood borne pathogens by reducing injection frequency and adoption of safe injection practices. AIMS: To assess the injection practices in a large metropolitan city encompassing varied socio-cultural scenarios. STUDY SETTING AND DESIGN: Field based cross sectional survey covering urban non-slum, slum and peri-urban areas of a large metropolitan city. METHODS AND MATERIAL: Injection prescribers, providers and community members selected by random sampling from the study areas. Pre tested questionnaires assessed knowledge and perceptions of study subjects towards injections and their possible complications. Observation of the process of injection and prescription audit also carried out. STATISTICAL ANALYSIS: MS Access for database and SPSS ver 11 for analysis. Point estimates, 95% confidence intervals, Chi Square, t test, one-way ANOVA. RESULTS: The per capita injection rate was 5.1 per year and ratio of therapeutic to immunization injections was 4.4:1. Only 22.5%of injections were administered with a sterile syringe and needle. The level of knowledge about HIV and HBV transmission by unsafe injections was satisfactory amongst prescribers and community, but inadequate amongst providers. HCV was known to a very few in all the groups. The annual incidence of needle stick injuries among providers was quite high. CONCLUSION: A locally relevant safe injection policy based on multi disciplinary approach is required to reduce number of injections, unsafe injections and their attendant complications.

Neurological manifestations of HIV infection.

Case records of HIV infected patients were analyzed for identifying neurological manifestations. Eight patients (7 males) were identified to have probable HIV encephalopathy (in a period of 24 months) as per the CDC revised classification system. Their ages ranged from one year to ten years. The neurological manifestations noted included-developmental delay (2 cases), seizures (6 cases), acute onset alteration of sensorium (4 cases), aphasia (2 cases), loss of vision (2 cases), focal neurological deficits (6 cases), brisk deep tendon reflexes (7 cases), extensor plantar responses (5 cases) and signs of cerebellar dysfunction (2 cases). Other clinical features included growth failure, microcephaly, fever, lymphadenopathy, hepatomegaly, splenomegaly, pneumonia, otorrhea and oral candidiasis. Cerebrospinal fluid studies were normal. The neuroimaging features included cerebral atrophy and ventricular dilatation, cerebral infarction, basal ganglia calcification and cerebellar atrophy. Childhood HIV infection may have a variety of neurological abnormalities. HIV infection should be suspected in children presenting with unexplained neurological manifestations and growth failure.

Neurological complications of rabies vaccines.

The rabies vaccines containing neural elements are used in some countries including India. We report three cases that presented with various neurological complications following the use of these vaccines. The presenting manifestations included those of encephalitis, radiculitis and acute inflammatory demyelinating polyradiculoneuropathy. These neurological complications are highlighted so that scientific evidence compels the community to discontinue the use of the neural tissue rabies vaccines. Newer generation cell culture rabies vaccines should be preferred over the neural tissue rabies vaccines for post-exposure prophylaxis.