Profile of Cardiac Involvement in Children After Exposure to COVID-19

Objective: To evaluate the incidence and pattern of cardiac involvement in children postCOVID (coronavirus disease) infection in a tertiary care referral hospital in India. Methods: A prospective observational study was conducted including all consecutive children with suspected MIS-C referred to the cardiology services. Results: Of the 111 children with mean (SD) age 3.5 (3.6) years, 95.4% had cardiac involvement. Abnormalities detected were coronary vasculopathy, pericardial effusion, valvular regurgitation, ventricular dysfunction, diastolic flow reversal in aorta, pulmonary hypertension, bradycardia and intracardiac thrombus. The survival rate post treatment was 99%. Early and short-term follow-up data was available in 95% and 70%, respectively. Cardiac parameters improved in the majority. Conclusion: Cardiac involvement post COVID-19 is often a silent entity and may be missed unless specifically evaluated for. Early echocardiography aids in prompt diagnosis, triaging, and treatment, and may help in favorable outcomes.

A comparative study of primary cellulitis and its local complications in lower limbs in diabetics and non-diabetics through the new Amit Jain’s staging system from India

Background: The objective of the study was to validate Amit Jain’s staging system for cellulitis in diabetic and non-diabetic lower limbs and to predict the outcomes associated with cellulitis and surgical procedures done in them.Methods: We conducted a prospective study in department of surgery at Raja Rajeswari Medical College and Hospital Bengaluru, India. The study period was from December 2018 to November 2019. Statistical analysis was done using SPSS 22 and R environment ver.3.2.2.Results: A total of 36 patients were included in this study of which 21 were diabetics and were in placed in group A and 15 were non diabetics and placed in group B. 83.3% of the patients were males. 73.3% of non-diabetics had stage 1 cellulitis and 33.3% of diabetics had stage 1 and 2 each. 47.2% of patients underwent debridement and it was significantly common in diabetics (p=0.037) and also it was common in higher stages of cellulitis (p=0.001). 8.3% had amputation in this series. All the major amputations were done in stage 4 cellulitis (p=0.002).Conclusions: In this validation study, it can be seen that cellulitis is common in both diabetics and non-diabetics but it is severe in diabetic patients. Stage 3 was more common in diabetics compared to non-diabetics. Amit Jain’s staging system of cellulitis is a simple, easy, practical, focal classification that guides therapy and predicts amputation.

Assessment of preoperative serum albumin level and its correlation with postoperative wound complication in major elective abdominal surgeries

Background: Patients who have signs of malnutrition have a higher risk of complications and an increased risk of death in comparison with patients who have adequate nutritional reserves. It is common and occurs in about 30% of surgical patients with gastrointestinal diseases and in up to 60% of those in whom hospital stay has been prolonged because of postoperative complications. The serum albumin level is the most readily available and clinically useful parameter. A serum albumin level greater than 3.5 g% suggests adequate protein stores and it confers a protective effect through several biological mechanisms. It predicts perioperative morbidity and mortality.Methods: Our study was conducted on a cohort of 100 Patients admitted in Department of General surgery Hamidia Hospital for major elective surgery between October 2016 and September 2017. Sample size taken was 100.Results: The present study shows that patients with serum albumin less than 3 g/dl has more postoperative complications and patients with serum albumin >3.5 g/dl has less postoperative complications which was statistically significant. The study concludes that as the serum albumin level increases the complication rate decreases.Conclusions: Our study shows that sr. albumin is a good indicator of postoperative complications. The patients with sr. albumin <3.0 g/dl had a higher complication rate which was statistically significant (p<0.05). Patients with sr. albumin >3.5 g/dl had less complications which was statistically significant (p<0.05). The correlation between the serum albumin and complication rate was statistically significant in the malignant diseases when considered separately.

Primary ileal volvulus: a rare cause of small intestinal obstruction

A 50-year-old lady presented to us in the emergency department with history of acute abdominal pain and vomiting since the past 24 hours. Abdominal examination showed tenderness and guarding in the hypogastrium, lumbar and right iliac fossa region. Initial diagnosis of ruptured appendicitis was considered but exploratory laparotomy gave us an intra-operative surprise. Small bowel volvulus is extremely rare in clinical practice and their symptoms are usually nonspecific. The diagnosis is typically confirmed at surgery most of the time just like in this case. No etiology of this volvulus was found in this patient. Ileal volvulus carries a significant risk of mortality. Awareness of this condition among surgeons will help to reduce the morbidity and mortality associated with this unusual form of intestinal obstruction.

Prognostication in Traumatic Brain Injury- A Prospective Study of 100 Patients in Tertiary Care Hospital in Rural Area.

Traumatic brain injury is a major health issue responsible for considerable mortality and morbidity worldwide especially in subjects under the age of 40 yrs. It is important to assess and grade the TBI as soon as possible to guide management and decrease the comorbidities. Various guidelines have been issued by the neurosurgical societies to immediately assess and intervene when ever required. In this study, we have tried to assess the role of basal cisternal effacement in the management and prognosis of RTA patients, and hence tried to simplify the prognostication process and improve the patient management.METHODS100 subjects were studied who were having history of traumatic head injury. NCCT was done for all the patients using 128 slice Multidetector CT- Ingenuity (Philips Medical Systems, USA). Other parameters like pupillary reaction, GCS at the time of presentation, midline shift and associated fractures and bleed were assessed. All the patients were followed up till the time of discharge. The data so obtained was analysed.RESULTSParameters like age, pupillary reflex, GCS at presentation, associated intracranial bleed, associated cranial vault fractures and presence or absence of midline shift correlated well with the final outcome with p value consistently <0.05. We analysed that the degree of obliteration of perimesencephalic cistern was a good prognostic marker in traumatic head injury patients. 36% of patients had favourable outcome out of which none of the patients had obliterated perimesencephalic cistern or interpeduncular cisterns. 64% patients had unfavourable outcome out of which 60% and 48% had obliterated or partially obliterated perimesencephalic cisterns and interpeduncular cisterns respectively, and only 4% and 16% had normal perimesencephalic cisterns and interpeduncular cisterns respectively.CONCLUSIONSIt is important to investigate, grade and prognosticate traumatic head injury patients at the earliest. Our study and various other studies prove that various clinical predictors including age, Glasgow coma scale, and pupil reactivity correlate with outcome of patient. Presence of midline shift, intraventricular haemorrhage, and obliteration of cisterns in patients of traumatic brain injury also correlate with the outcome and can be used; thus, making the prognostication process much easier. These findings can be used on the first day of admission itself.

Prescription pattern of alpha blockers in the treatment of benign prostatic hyperplasia in India: a paper based survey

Background: Benign prostatic hyperplasia (BPH) is the most common urological condition. The treatment of BPH depends on the severity of symptoms which aims to improve symptoms, lower the risk of progression and improve quality of life. The aim of this survey was to understand the prescription pattern of alpha blockers in the treatment of BPH among clinicians of India.Methods: A cross-sectional questionnaire-based survey was conducted between September to December 2018. Data regarding the management of BPH using ?-blockers were filled by clinicians and collated for data analysis using appropriate statistical test.Results: Total of 1764 clinicians’ responses was collected and the result was analysed. According to the survey, 47.68% of clinicians felt that severity of the BPH symptoms is most common deciding factor for medical management of BPH. For the pharmacological management of BPH patients, around 58% of clinicians opted for ? blockers monotherapy as a preferred option. Among ? blockers, 65.14% of clinicians preferred tamsulosin as first line therapy for management of BPH patients. In this survey, 81.75% of clinicians believed that tamsulosin offers highest persistence rate among commonly prescribed ? blockers. Looking at the switching to a second ?-blocker, 75.45% of clinicians felt that tamsulosin shows the highest return rate following initiation of a second ?-blocker. More than 90% of clinicians felt that favourable efficacy or tolerability of tamsulosin is due to its highest persistence and highest return rates.Conclusions: Tamsulosin is the most commonly preferred and prescribed ?-blocker by Indian clinicians due to its favourable efficacy or tolerability.

Effect Of Acetone Soluble And Acetone Insoluble Fractions Of Allium Cepa On Some Animal Models Of Asthma

Current Asthma therapy lack satisfactory effect due to various adverse effects, hence patients are moving to Ayurveda. Researchers conducted studies in last decades on plants mentioned in Ayurveda used for asthama has shown Anti-asthamic, Anti-histaminic and Anti-allergic activity. Present study is conducted to study the anti-asthmatic activity of acetone soluble and insoluble extract of Allium cepa. In this process dried peels of Allium cepa were immersed in 95% ethanol for 48hr and the extract obtained was further fractionated with anhydrous acetone to get acetone soluble (ASF) and acetone insoluble (AIF) fractions. Effect of the fractions was studied on isolated goat tracheal chain suspended in Kreb’s solution and percentage contractile response was measured. Albino Swiss mice (22-25g) of either sex were subjected to milk- induced leucocytosis and eosinophilia to study adaptogenic and anti-allergic activity respectively. Effects of both the extracts were also studied on clonidine-induced catalepsy and clonidine induced mast cell degranulation in mice as a measure of central and peripheral mast cell stabilization respectively. Wistar rats (150-180g) were used to study effect of fractions on passive paw anaphylaxis to study immunomodulatory and anti-inflammatory activity.

Posterior Fossa Lesions– An Experience Of 32 Cases Over 2 Years

INTRODUCTION- 1 Posterior fossa tumours are common in paediatric population ; however their occurrence in adults is not rare. They form a major cause of morbidity and mortality in either population. Some of these tumours like pilocytic astrocytomas are rewarding, others, like medulloblastomas may have a poor outcome. This study aims to analyse the epidemiology and surgical outcomes of posterior fossa lesions. MATERIALS AND METHODS – This is a retrospective study done at Dr. B.R.A.M. Hospital between April 2016 and June 2018. It included 32 patients with posterior fossa lesions.Cerebellopontine angle lesions- schwannomas, epidermoids were excluded. Only lesions involving the cerebellum or occupying the fourth ventricle were included in the study. Their surgical outcome in terms of complications and mortality were analysed. RESULTS-Thirty –two patients, in the age group of 2years to 68 years were included in the study. Cerebello-pontine angle lesions were excluded. Only lesions involving the cerebellum or occupying the fourth ventricle were included in the study. Most common lesion was medulloblastoma, followed by pilocytic astrocytoma, cerebellar abscess, haemangioblastoma, arachnoid cyst, exophytic tectal gliomas, tuberculoma, metastasis, epidermoid. They underwent surgery depending upon the nature of lesion. Overall mortality was found in 9 of 32 patients. Mortality was especially high in medulloblastoma patients (54.55%). CONCLUSIONS – Various lesions may affect the posterior fossa, varying from neoplastic malignant or benign lesions to infective and developmental lesions. Medulloblastoma is a common tumour in the paediatric population and carries a bad prognosis

Comparison of drug information in package inserts with standard medical textbook of pharmacology

Background: Accurate and reliable drug product information is important for the safe and effective use of medicines. But there are variations in the quantity and quality of information mentioned in different drug information sources and a single credible benchmark is lacking. This study was carried out to compare the presentation and completeness of clinical information in package inserts (PIs) marketed by pharmaceutical companies in India with standard medical textbook of pharmacology.Methods: Out of eighty five PIs of different drugs, only 55 were found eligible to be included in this study after applying inclusion and exclusion criteria. These PIs and medical textbook were analysed for quantitative and qualitative drug information and were compared using Chi square test of two proportions. The p value of 0.05 was used as cut off to evaluate statistical significance.Results: Quantitatively medical textbook was significantly better statistically in context of treatment of overdose and references. No statistically significant difference was observed in relation to information related to mechanism of action (MOA) and pharmacokinetics (Pk). After qualitative analysis, medical textbook was significantly better statistically in context of size and readability, references related to adverse drug reactions (ADRs) and indications and pictures. No statistically significant difference was observed in context of dosing interval, frequency of doses and pharmacokinetic parameters.Conclusions: PIs can be used as a reliable source of drug information by health care professionals in addition to other sources like medical textbooks.

Clinical Implication of ApoB (12669G/A) Gene Polymorphism and Risk of Cardio Vascular Disease in Indian Population

Background: Cardiovascular disease is rising day by day due to having high fat diet and due to genetic alterations. Materials & Methods: Study included 70 CVD patients and their peripheral blood samples were collected for genotyping by venipuncture under aseptic condition in EDTA vials (2ml) as well as in serum vials (3ml) for biochemical parameters. Genomic DNA extraction was done by phenol chloroform method from blood samples collected in EDTA vials from cases as well as controls for genotype study. Results: The difference of genotype between cases and controls was found to be significant (p=0.0003). Study observed that high percentage of GA 29 (41.4%) and AA 8 (11.4%) genotype was found in patients compared to controls GA 10 (20%) and AA 0 (0%) while lower GG 33 (47.2%) genotype in patients compared to control GG 40 (80%) genotype. Compared to the GG genotype, the OR 3.51 (1.49-8.25) and 20.55 (1.14-369.6) for the heterozygous GA and homozygous AA genotypes were estimated, suggesting a possible dominant effect of Apo B polymorphism on CVD risk. In smokers, compared to the GG genotype, the OR 2.19 (0.69-6.88) and 1.71 (0.29-9.87) for the heterozygous GA and homozygous AA genotypes. In alcoholism, compared to the GG genotype, the OR 2.66 (0.93-7.57) and 8.4 (0.92-76.19) for the heterozygous GA and homozygous AA genotypes. Patients with mutant  homozygous AA, heterozygous GA genotypes showed 123.3+14.34 (mg/dl) and 76.92+24.09 Apo B level in CVD patients compared to wild type GG homozygous genotypes were 70.82+17.12. Conclusion: It was observed that Apo B gene polymorphism and smoking behaviour found to be associated with increased risk of CVD in Indian population.

Micro RNAs and Non-Small Cell Lung Cancer

Non-small cell lung cancer is a major leading cause of cancer-related death and its late diagnosis/prognosis, accounting for the high rate of mortality. Presences of circulating microRNAs (miRNAs) in body fluids represent stable and reproducible biomarkers for several solid tumors, including non-small cell lung cancer. Micro RNAs have been categorized as oncogenic microRNAs and “tumor suppressor micro RNAs” and miRNAs activities may provide exciting opportunities for early cancer detection. There is an urgent need to find a less invasive and a more reliable biomarker which can increase the probability of early non-small cell lung cancer detection.

Clinical outcome and regression patterns of retinoblastoma treated with systemic chemoreduction and focal therapy: A prospective study.

Purpose: To prospectively study the clinical outcome and regression patterns of early retinoblastoma (Groups A and B) after systemic chemotherapy and focal consolidation in Indian children. Materials and Methods: Group A eyes were treated with focal therapy (transpupillary thermotherapy/cryotherapy) and Group B with systemic chemoreduction and focal therapy. Outcome measures were efficacy and safety of treatment, risk factors for treatment failure, regression patterns, and factors predictive of regression patterns. Results: Of 119 eyes (216 tumors), 14 (11.8%) were Group A and 105 (88.2%) were Group B eyes. The mean follow‑up was 22.6 months. Tumor control was achieved in 111/119 eyes (93.3% overall, 100% Group A, 92.4% Group B). Eight Group B eyes (6.7%) had treatment failure. No serious systemic side‑effects were noted. Risk factors for failure included larger tumors (P = 0.001) and proximity to posterior pole (P = 0.014). Regression patterns were Type 4 (50.2%), Type 3 (31.7%), Type 1 (11.1%), and Type 2 (7%). Factors predictive of Type 4 regression were smaller tumors, anterior location, younger age; Type 3 regression was associated with larger tumors, macular location, and older age. Conclusions: Systemic chemoreduction and focal therapy provided effective tumor control in Indian children. Factors predictive of regression patterns included age, tumor size and its location, and the modality of treatment.

Multiple jejunal perforations in dengue.

Gastrointestinal perforation is one of the common complications that are associated with high mortality. Stomach, duodenum, ileum and colon are common site of perforation whereas jejunum is an uncommon site for perforation. We report an interesting case of jejunal perforation that occurred in a female patient. To our knowledge, this is the first such isolated case of multiple jejunal perforation in dengue that is being reported in the literature.

Comparison of the conventional CMAC and the D-blade CMAC with the direct laryngoscopes in simulated cervical spine injury-a manikin study / Comparação do C-MAC convencional e C-MAC D-blade com laringoscópios diretos em simulação de lesão da coluna cervical-estudo em modelo / Comparação do C-MAC convencional e C-MAC D-blade com laringoscópios diretos em simulação de lesão da coluna cervical-estudo em modelo / Comparación del C-MAC convencional y C-MAC D-blade con laringoscopios directos en simulación de lesión de la columna cervical (estudio en modelo)

BACKGROUND: CMAC videolaryngoscope has recently been introduced for videoscope guided intubation. The aim of our study was to compare and evaluate the efficacy of the conventional blade and the angulated D blade of the CMAC videolaryngoscope with the direct laryngoscopes in simulated cervical spine injury patients on the airway manikin. MATERIALS AND METHODS: Following power analysis, 33 resident doctors were enrolled to perform endotracheal intubation using all the 4 different laryngoscopes namely the Macintosh laryngoscope, McCoy laryngoscope, conventional CMAC videolaryngoscope and the D blade of the CMAC videolaryngoscopes on the airway manikin in simulated cervical spine injury. The demographic variables of the resident doctors were recorded. The outcomes measured included vocal cord visualization (Cormack-Lehane grading), time taken to intubate, number of attempts for successful intubation and optimizing maneuvers required. RESULTS: The use of indirect videolaryngoscopes resulted in better glottic visualization in comparison to the direct laryngoscopes (CL-I) in 20/33 (60.6%) in the Macintosh group, 24/33 (72.7%) in McCoy group, 30/33 in (90.9%) in Vlc group and 32/33 (96.9%) in Vld group. The time taken to intubate averaged to 15.54 ± 2.6 in Macintosh group, 18.90 ± 4.47 in McCoy group, 20.21 ± 7.9 in Vlc group and 27.42 ± 9.09 in Vld group. The 1st attempt intubation success rate was 84.8% (Macintosh), 72.7% (McCoy), 90.9% (Vlc) and, 78.7% (Vld). CONCLUSIONS: The overall performance of the conventional CMAC blade proved to be the best when compared with the D-blade CMAC, Macintosh blade and the McCoy blade for intubation in simulated cervical spine patients by anesthesia residents. .

JUSTIFICATIVA E OBJETIVO: o videolaringoscópio C-MAC foi recentemente introduzido para orientar a intubação. O objetivo deste estudo foi comparar e avaliar a eficácia do laringoscópio C-MAC de lâmina convencional e C-MAC de lâmina angulada (D-blade) com laringoscópios diretos em simulação de pacientes com lesão de coluna cervical usando modelo de vias aéreas. MATERIAIS E MÉTODOS: após a análise do poder do estudo, 33 médicos residentes foram inscritos para realizar intubações endotraqueais, usando todos os quatro laringoscópios diferentes: laringoscópio Macintosh, laringoscópio McCoy, videolaringoscópios C-MAC convencional e C-MAC D-blade em modelos de vias aéreas com simulação de lesão da coluna cervical. As variáveis demográficas dos médicos residentes foram registradas. Os resultados avaliados incluíram visualização das pregas vocais (classificação de Cormack-Lehane), tempo necessário para intubar, número de tentativas para intubação bem-sucedida e manobras de otimização necessárias. RESULTADOS: o uso de laringoscópios indiretos resultou em melhor visualização da glote em comparação com os laringoscópios diretos (CL-I) em 20/33 (60,6%) no grupo Macintosh, 24/33 (72,7%) no grupo McCoy, 30/33 (90,9%) no grupo Vlc e 32/33 (96,9%) no grupo Vld. A média do tempo necessário para entubar foi de 15,54 ± 2,6 no grupo Macintosh, 18,90 ± 4,47 no grupo McCoy, 20.21 ± 7,9 no grupo Vlc e 27,42 ± 9,09 no grupo Vld. A taxa para a primeira tentativa de intubação bem-sucedida foi de 84,8% (Macintosh), 72,7% (McCoy), 90,9% (Vlc) e 78,7% (Vld). CONCLUSÃO: o desempenho geral da lâmina do C-MAC convencional mostrou ser melhor quando comparado com o das lâminas ...

JUSTIFICACIÓN Y OBJETIVO: el videolaringoscopio C-MAC fue recientemente introducido para orientar la intubación. El objetivo de este estudio fue comparar y evaluar la eficacia del laringoscopio C-MAC de lámina convencional y C-MAC de lámina angulada (D-blade) con laringoscopios directos en una simulación de pacientes con lesión de la columna cervical usando modelo de vías aéreas. MATERIALES Y MÉTODOS: después del análisis del poder del estudio, 33 médicos residentes fueron inscritos para realizar intubaciones endotraqueales, usando 4 laringoscopios diferentes: laringoscopio Macintosh, laringoscopio McCoy, videolaringoscopios C-MAC convencional (Vlc) y C-MAC D-blade (Vld) en modelos de vías aéreas con simulación de lesión de la columna cervical. Las variables demográficas de los médicos residentes fueron registradas. Los resultados evaluados incluyeron la visualización de las cuerdas vocales (clasificación de Cormack-Lehane), tiempo necesario para intubar, número de intentos para intubación exitosa y maniobras de optimización necesarias. RESULTADOS: el uso de laringoscopios indirectos trajo como resultado una mejor visualización de la glotis en comparación con los laringoscopios directos (CL-I) en 20/33 (60,6%) en el grupo Macintosh, 24/33 (72,7%) en el grupo McCoy, 30/33 (90,9%) en el grupo Vlc y 32/33 (96,9%) en el grupo Vld. El tiempo medio necesario para intubar fue de 15,54 ± 2,6 en el grupo Macintosh; 18,90 ± 4,47 en el grupo McCoy; 20,21 ± 7,9 en el grupo Vlc; y 27,42 ± 9,09 en el grupo Vld. La tasa para el primer intento de intubación exitoso fue de un 84,8% (Macintosh), un 72,7% (McCoy), un 90,9% (Vlc) y un 78,7% (Vld). CONCLUSIÓN: el rendimiento global de la lámina del C-MAC convencional mostró ser mejor cuando se le comparó con el de las láminas ...

Conservative treatment modalities in retinoblastoma.

Retinoblastoma is the most common primary intraocular malignancy of childhood. A potentially curable cancer, its treatment has improved significantly over the last few decades. The purpose of this article is to review the literature on various conservative treatment modalities available for the treatment of retinoblastoma and their effectiveness, when used alone or in combination. Pubmed, Medline, Embase, and the Cochrane library were searched through 2012 for published peer reviewed data on conservative treatment modalities for retinoblastoma. Various studies show that while enucleation remains the standard of care for advanced intraocular tumors, conservative modalities that can result in globe salvage and preservation of useful vision are being increasingly employed. Such modalities include systemic chemotherapy, focal consolidation with transpupillary thermotherapy, laser photocoagulation and cryotherapy, plaque brachytherapy, and delivery of local chemotherapy using subconjunctival, sub‑tenon, or intra‑arterial routes. When used alone or in combination, these treatment modalities can help in avoidance of external beam radiotherapy or enucleation, thus reducing the potential for long‑term side effects, while salvaging useful vision. Radioactive plaque brachytherapy has an established role in selected patients with intraocular retinoblastoma. Local injections of chemotherapeutic agents via the sub‑tenon or sub‑conjunctival route have been used with varying degrees of success, usually as an adjunct to systemic chemotherapy. Intra‑arterial ophthalmic artery delivery of melphalan has shown promising results. It is important to recognize that today, several treatment options are available that can obviate the need for enucleation, and cure the cancer with preservation of functional vision. A thorough knowledge and understanding of these conservative treatment modalities is essential for appropriate management.