Knowledge about COVID-19 Infection and Stress Levels among Ambulance Drivers during COVID-19 Pandemic — A Cross Sectional Study

Introduction : The medical personnel especially have to deal with both the Biological and Psychological consequences originating from the influence of virus. Emergency Care Units equipped with ambulance service always should be at the fore front to face all emerging untoward incidents. Ambulance Drivers often disregard their physical health and mental stress in order to fulfil the duties entrusted on them. Methodology : Cross-sectional questionnaire based on-line survey was conducted. Ambulance drivers were North and South India were taken as study subjects. Knowledge based questions and mental stress were assessed using Perceived Stress level Scale (PSS). The questionnaires were translated toTamil, Kannada, Telugu, Malayalam and Hindi languages. Chi-square test was done to find the association between variables. Results : Among the 101 respondents, 84.2% were having good knowledge about the pandemic. Statistically significant association between number of patients transported per day and the knowledge levels of Ambulance drivers was found (p =0.048)(Chi-square value=15.65). Drivers in Government sector were having more knowledge compared to private sector (p =0.038)(Chi square value=6.53). The perceived mental stress was found to increase with a greater number of patients being transported per day, which was statistically significant (p =0.001)(Chi-square value= 30.42). Conclusion : Knowledge regarding COVID-19 virus was adequate among the Ambulance Drivers. Knowledge was found to be more among drivers who work in Government medical establishments. Mental stress was more among drivers who transported more than 5 patients per day.

Assessment of renal involvement in patients with systemic lupus erythematosus in a tertiary care hospital

Background: Renal involvement in SLE is common. Lupus Nephritis is the major cause of mortality in SLE patients. Renal involvement is a severe form of the disease and subsequent management is planned according to the histopathological class of lupus nephritis. Thus, this study was planned to assess the clinical profile and the extent of renal disease in SLE patients.Methods: A prospective observational study was conducted among SLE patients who got admitted in the Department of General Medicine and Nephrology in Thanjavur Medical College Hospital, Thanjavur from July 2012 to October 2013. Fifty SLE patients who had renal symptoms were included in this study.Results: SLE is Common among females. Common renal presentations were haematuria and proteinuria. 42% of the patients had Class IV lupus nephritis, followed by 24%, 16%, 16%, and 2% of Class III, II, Class V and Class I lupus nephritis respectively. No case of class VI lupus nephritis was reported in this study. ANA was positive among 66%, Anti ds DNA was positive in 64% and C3 level was found to be reduced in 50% of patients. Antiphospholipid antibodies were seen in 2% of the patients.Conclusions: Proteinuria, haematuria, a lower serum C3 level and need for aggressive hypertension management were prominently seen with a worse class of lupus nephritis. Patients with active and proliferative forms of lupus nephritis had a severe course of illness and required aggressive management with immunosuppressants.

Glycemic Control and Long-term Complications in Pediatric Onset Type 1 Diabetes Mellitus: A Single-center Experience from Northern India

Objective: To study glycemic control, mortality and long-termcomplications in children with type 1 diabetes (T1D).Design: Cross-sectional study.Setting: Referral centre at a government teaching hospital.Participants: Patients with T1D with age ≤18 years at onset.Methods: We retrospectively collected demographic data fromcomputer records from 1991 to 2015. Prospective study foroutcomes was conducted between 2012 and 2016.Main outcome measures: Mortality rate, glycosylatedhemoglobin (HbA1c), and microvascular complication rate.Results: The proportion of T1D patients (n=512) <5 years of ageat onset was 18.6% between 1995 and 2004, and 24.2% in2005-2014 (P<0.001). Twenty eight patients had died out of 334whose living status was known (mortality 1.1 per 100 patient-years over 2549 patient-years follow up). Median (range)HbA1c (n=257) was 8.3% (5.1-15.0%). At least one episode ofsevere hypoglycemia (coma/seizure/inability to assist self) hadoccurred in 22.8% patients over two years. Hypertension waspresent in 11.7% patients. Microvascular complications screenin 164 eligible patients [median (range) age 20 (8-45) y andduration of diabetes 9.1 (5-30) y] showed diabetic nephropathy in3.0%, proliferative retinopathy in 3.6% and LDL cholesterol >100mg/dL in 34% patients.Conclusion: The mortality rate and prevalence of hypertensionwere high, given the short duration of diabetes of the patients.The proportion of patients with age ≤5 years at onset of diabeteshas increased at our center.

EFFECT OF NICORANDIL ON PENTYLENETETRAZOLE (PTZ) INDUCED CONVULSIONS IN MICE

Aims & Objectives: To evaluate or screen the anticonvulsant effect of Nicorandil a potassium channel opener in Pentylenetetrazole(PTZ) induced convusions in albino mice. Materials & Methods: Mice of either sex weighing 20-25gms were selected for the present study. The animals were divided into 6 groups with each group consisting of 6 albino mice. Group 1 mice received placebo (0.2ml of distilled water) intraperitoneally (i.p), group 2 received sodium valproate 200 mg/kg/i.p. as positive control, while groups 3,4, 5 and 6 were administered Nicorandil 5, 10, 20 and 40 mg/kg i.p respectively. Pentylenetetrazole (PTZ) was administered in the dose of 100mg/kg i.p, 30mins after Nicorandil/ control drug pre-treatment. Onset and duration of clonic convulsion were recorded. Results: Nicorandil pretreatment in the dose of 5mg/kg increased onset time and significantly decreased the duration of convulsions,while the doses of 10, 20, 40mg/kg prevented the convulsions. Conclusion: Nicorandil possesses significant anticonvulsant activity comparable to sodium valproate on PTZ induced seizure in albino mice.

Benign Triton Tumor: A Rare Entity in Head and Neck Region

Benign triton tumors (BTT) are very rare lesions composed of mature skeletal muscle and neural tissue. We report a case of a 14-year-old boy who presented with asymptomatic swelling of the chin over an 18-month duration which increased gradually to involve the left side of the lower lip. Clinically, a diagnosis of neurofibroma was made. Excisional biopsy confirmed the diagnosis of a BTT. Having an affinity for large nerve trunks like the brachial and sciatic, these tumors rarely occur in the head and neck region. When they do, they may involve the large central cranial nerve trunk and present as intracranial masses or involve the smaller peripheral nerve twigs and present as asymptomatic skin nodules, of which only four cases involving peripheral nerves are reported in the English literature. Here, we report the fifth documented case of a BTT involving the mental branch of the trigeminal nerve. A brief review of the literature is also provided.

Role of tranexamic acid in reducing postoperative blood loss and transfusion requirement in patients undergoing hip and femoral surgeries

Pharmacological agents are used to reduce postoperative blood loss. To assess the effects of tranexamic acid on prevention of bleeding and requirement of blood transfusion after major hip and femoral surgeries. A prospective, randomized, double blinded study was conducted in the tertiary care teaching hospital. Ninety ASA grade I-II patients undergoing hip fracture surgery were included in this prospective study. Forty-five patients received tranexamic acid [TA] given in a bolus dose of 500 mg 15 min before surgical incision followed by continuous infusion. The remaining, 45 patients were allocated as a control group. Postoperative bleeding [volume of blood in the drain], percentage fall of hemoglobin, transfusions and complications were recorded. Mean volume of blood in the drain was 39.33 +/- 10.09 ml [mean +/- SD] as compared to 91.11 +/- 17.61 ml in placebo group showing a P<0.001. Mean percentage fall in Hb at day 0 was 2.99 +/- 3.45 in the study group as compared to 7.70 +/- 6.05 in the placebo group [P<0.001], and fall at day 2 in the study group was 0.35 +/- 0.74, compared to 2.72 +/- 2.70 in the placebo group [P<0.001]. The number of patients required blood transfusions were lower in the study group than in the placebo group [P=0.01]. We conclude that tranexamic acid significantly reduces postoperative blood loss and transfusion requirements during major hip and femoral surgeries

Septicemia due to ESBL producing klebsiella pneumoniae in multi transfused thalassemic patient with splenectomy.

The spleen plays a major role in the opsonisation of capsulated bacteria. A thalassemic patient is treated with prophylactic antibiotics, vaccines, chelating agents, blood transfusions and many a time, with splenectomy. The surgery predisposes patients to infections with capsulated organisms.Vaccines can prevent occurrence of streptococcal and haemophilus infections to some extent. However Gram negative septicaemia due to capsulated bacteria can be overwhelming in these patients and when caused by multidrug resistant strains can warrant the need for administration of expensive antibiotics to save the life of the patient.

An in vivo comparative evaluation to determine the accuracy of working length between radiographic and electronic apex locators.

Background: An in vivo comparative evaluation to determine the accuracy of working length between radiographic and electronic apex locators. Aim: The study was aimed at evaluating the accuracy of electronic apex locator, to determine the working length of root canal, and to compare it with the radiographic method of working length determination. Materials and Methods: A total of 20 teeth selected for the study had to go for extraction because of periodontal or orthodontic reasons. Access cavity was prepared and the clinical estimated working length (CEWL) was determined with 10-25 no. K-file. A radiograph was then taken for determining the radiographic estimated working length (REWL). For electronic measurement of root canal, a 10 no. K-file was advanced toward the apex until it reached a 0.5 mm short of apex as shown by the apex locator. After fixing the file with a light cured composite, the tooth was extracted, the tooth surface was then longitudinally grounded using straight fissure diamond bur until the root canal and the tip of the file were visible. The distance of file from the minor constriction was measured with help of stereomicroscope. Statistical analysis : The chi-square test was used for statistical analysis for this study. Results: The chi-square test where χ2 = 21.034 with P = 0.000 indicated that a significant difference exists among the groups. The electronic method showed highest number of cases with the working length at the minor constrictor. Conclusion: The electronic method for determining the working length of root canal was found to be more accurate than the radiographic method.

Effect of cavity varnish and intermediate restorative material on coronal microleakage in endodontically treated tooth.

Aim: Evaluation of microleakage in endodontically treated teeth that have been coronally sealed with eugenol and noneugenol containing zinc oxide cement, with and without the use of cavity varnish. Materials and Methods: The crowns of single rooted teeth were removed at the cementoenamel junction (CEJ) and the root canals were prepared and obturated with gutta-percha points and zinc oxide eugenol (ZOE) sealer using lateral condensation technique. The samples were randomly divided into four groups-group 1, coronal seal was obtained with ZOE cement; in group 2, three coats of cavity varnish followed with coronal seal of ZOE cement; in group 3, Litark a (noneugenol cement) was placed in the prepared cavity as in group 1; and in group 4, cavity varnish and Litark were placed instead of ZOE as in group 2. The specimens were immersed in 2% methylene blue dye and examined under traveling microscope for evidence of dye penetration of the material. Statistical Analysis: In this study, Kruskal-Wallis test, Mann-Whitney U, and Wilcoxon W tests were used. Results: Kruskal-Wallis test with P=0.000 indicated that a significant difference exists between the four groups. Mann-Whitney U test and Wilcoxon W test showed a significant difference at 0.05 levels as follows: group 1 with group 3 and 4, group 2 with group 3 and 4, and group 3 with group 4. There was no significant difference at 0.05 levels between group 1 and group 2. Conclusion: Group 4 showed significant less amount of dye penetration as compared with other groups.

CSF dynamics study in clinical practice: An evaluation of the bolus lumbar injection method

Cerebrospinal outflow resistance measurement [R[out]] is useful in the diagnosis, evaluation and monitoring of many disease states. The bolus lumbar injection method has been employed, using simple improvised bedside apparatus, to measure R[out] in various disease states affecting cerebrospinal fluid [CSF] dynamics, including normal pressure hydrocephalus [NPH], pseudotumour cerebri, post-meningitic and post-haemorrhagic hydrocephalus, using Marmarou's formula after establishing the R[out] values in normal population. In normal population, R[out] values ranged from 3.878-9.669 mm Hg/min/ml [mean 6.09 mmHg/min/ml]. Patients with normal pressure hydrocephalus, pseudotumour cerebri, and post-meningitic and post-haemorrhagic hydrocephalus had significantly higher R[out] values. The bolus lumbar injection method is a simple, fairly accurate, less expensive method for bedside measurement of CSF outflow resistance, which is affected in various disease states. R[out] values in normal Indian subjects is slightly lower than the other reported values for normal subjects. R[out] values correlated well with the outcome after shunt, in normal pressure hydrocephalus and other types of communicating hydrocephalus, and hence is a useful parameter for selection of patients for shunt surgery. It is also useful in establishing the diagnosis of pseudotumour cerebri