JournalTOCs

Asian Journal of Medical Sciences
Number of Followers: 2

This is an Open Access Journal

Open Access journal
ISSN (Print) 2467-9100 - ISSN (Online) 2091-0576
Published by Nepal Journals Online

[114 journals]

A comparative study of wave 1 and 2 mortality factors among COVID-19
patients in a level 3 medical college hospital in Saharanpur India
- Authors: Devinder Kumar Vohra, Nawab Singh, Manchanda JK, Sanjeev Davey, Arvind Trivedi, Anuradha Dave, Kayanat Nasser
  Pages: 1 - 6
  Abstract: Background: In COVID-19, second wave death rate climbed in several states of India including Uttar Pradesh with relatively high number of casualties as compared to first wave. The literature lacks scientific reason behind this. Aims and Objectives: The present study aimed toward detection of mortality factors for COVID-19 patients from a Level 3 Medical College Hospital in both waves in Western UP District in India so as to find a better treatment strategies for COVID-19 patients for possible next 3rd COVID-19 wave. Materials and Methods: This study is aimed to find any difference in Wave 1 and 2 mortality factors among COVID-19 patients in a Level 3 Medical College Hospital in western up district Saharanpur in India from April 1, 2020 to Sep 30, 2021. Results: Although there were more number of deaths in Wave 2 (n=537) as compared to Wave 1 (n=172), deaths even after treatment of COVID-19 were more in wave 1 (72%) as compared to wave 2 (67.9%), but it was not statistically significant (P>0.05). In COVID -19, Wave 1 most of the patients were elderly (aged >60 years) (40.3%) whereas in Wave 2 45–60 years age group were more affected (40.5%). Presence of more than 2 comorbidities was also seen more in wave 1 (37.1%) as compared to Wave 2 (23.8%). In COVID-19, both Waves (1 and 2) the most common co-morbidity was Type2DM (52% and 36.4%, respectively), but DM was found to be more in COVID+ve patients of Wave 1 as compared to wave 2 COVID+ve patients whereas any CARDIAC abnormality co-morbidity was found more in Wave 2 patients as compared to Wave 1 (14.2% vs. 12.1%). Conclusion: Possibly COVID-19 virus operated differently at Cardio-respiratory system leading to increased mortality in COVID-19 patients in Wave 2.
  PubDate: 2022-05-03
  DOI: 10.3126/ajms.v13i5.41558
  Issue No: Vol. 13, No. 5 (2022)
A study on clinico-radiological profile, risk factors, and management of
mucormycosis during COVID pandemic in Rewa, (M.P.)
- Authors: Pallavi Indurkar, Aashutosh Asati, Yasmeen Siddiqui, Shubhangi Nayak, Manoj Indurkar
  Pages: 7 - 12
  Abstract: Background: Second wave of coronavirus disease 2019 (Covid-19) pandemic has been particularly devastating in India. COVID-19 and mucormycosis (also known as black fungus) are causing comorbid conditions to worsen the extent of infection and mortality rates especially in India. Mucormycosis can involve nose, sinuses, orbit, central nervous system, lung (pulmonary), gastrointestinal tract any many other organs, but rhino orbital cerebral mucormycosis is the most common variety seen. Rapidity of dissemination of mucormycosis is an extraordinary phenomenon and a delay in the diagnosis could be fatal. Aims and Objectives: The objective of this study is to document the clinical features, radiological extent, risk factors, management,
  and outcome of mucormycosis. Materials and Methods: The study was retrospective observational study. Eighty-two mucormycosis patients admitted in SGMH Rewa were selected as study subjects. Data regarding clinical features, radiological extent, associated risk factors, comorbidities, management during hospital stay, and outcome of mucormycosis patients were collected on excel sheet and analyzed using appropriate statistical tests. Results: In our study, majority of the patients were unvaccinated (88%). Most common presenting complaint was nasal congestion with or without discharge in 78% patients followed by Facial swelling, visual disturbances, facial weakness, dental pain, etc. On CT or magnetic resonance imaging examination, all cases of mucormycosis had maxillary sinus (100%) involvement, followed by ethmoid (82%) and sphenoid (78%) sinuses. Diabetes mellitus was most common comorbidity seen in 52% cases. About 83% cases had history of receiving high dose steroid intravenously during management of COVID illness. Among study cases 72% patients have taken oxygen supplementation for more than 72 h, for COVID-19 pneumonia before hospitalization for mucormycosis. Therapy of Liposomal Amphotericin B and Oral Triazole (predominantly oral Posaconazole) was the most common medical treatment offered to all patients with COVID associated mucorpatient. Functional endoscopic sinus surgery was done on 93% cases followed by Modified Denker’s procedure was done in 12% cases. Conclusion: In our study, mucormycosis appears to be associated with COVID-19, diabetes, and use of corticosteroids. Full vaccination with COVID-19 vaccines, judicious use of corticosteroids in patients with COVID-19 and strict control of blood glucose level along with timely and proper management is highly recommended to reduce the incidence of fatal mucormycosis.
  PubDate: 2022-05-03
  DOI: 10.3126/ajms.v13i5.43940
  Issue No: Vol. 13, No. 5 (2022)
Assessment of variations in selective biochemical parameters and its
correlation with age and gender in COVID-19 patients of Ujjain district: A
retrospective study
- Authors: Prashant Keshavrao Nichat, Sai Sailesh Kumar Goothy, Pavan Motilal Sonker, Gajanan Govind Potey, Ashish Pathak, Sudhir Gawarikar, Vijay Khanderao Mahadik
  Pages: 13 - 17
  Abstract: Background: At Ujjain district, in which the current study is based, has no prior studies examining the variations of liver function tests in the resident population. Aims and Objectives: The present study was undertaken to assess the variation in selective biochemical parameters and their correlation with age and gender in COVID-19 patients of Ujjain district: A retrospective study. Materials and Methods: 199 cases of confirmed COVID-19 patients from June 2020 to November 2020 were admitted to R. D. Gardi Medical College, Ujjain, Madhya Pradesh, were part of the study. Aspartate aminotransferases (AST), Alanine aminotransferases (ALT), Alkaline phosphatases (ALP), Total protein (TP), Total bilirubin (TB), C-reactive protein (CRP), Lactate dehydrogenase (LDH), sodium, and potassium parameters were recorded in the study participants. AST, ALT, TP, TB, CRP, and LDH were analyzed using vitros 5600 integrated system which is a dry chemistry autoanalyzer of ortho clinical diagnostics. Sodium and potassium analysis were analyzed on the vitros 5600 integrated system by using the direct potentiometry principle. The data were obtained from the patient information sheet from the MRD of our hospital. Results: The study results present the age-wise and gender-wise correlation of the parameters. There was an increase in the AST, ALT, CRP, and LDH levels in both male and female participants. However, the difference is not statistically significant. ALP, TP, TB, and potassium levels are within the normal limits in male and female participants. Albumin levels were decreased in male and female participants. However, the difference was not statistically significant. Sodium levels were significantly decreased (P<0.05) in males when compared with females. Conclusion: The study assessed the variations in selective biochemical parameters and their correlation with inflammatory markers in COVID-19 patients of the Ujjain district. The study results help to understand the biochemical aspects of the Covid disease. Further, detailed studies are recommended to understand the role of the biochemical parameter which helps for early diagnosis to save the life of the covid patients in general.
  PubDate: 2022-05-03
  DOI: 10.3126/ajms.v13i5.42506
  Issue No: Vol. 13, No. 5 (2022)
Assessment of adverse events following first dose of COVISHIELD in
healthcare workers of a tertiary care hospital in western Uttar Pradesh: A
prospective observational study
- Authors: Shivangna Singh, Suchi Jain, Bushra Hasan Khan, Vivek Gautam, Mayank Batola
  Pages: 18 - 22
  Abstract: Background: COVID‑19 pandemic is a great health challenge around the world. Immunization appears best preventive strategy where monitoring the safety of COVID-19 vaccines is immensely important as limited safety data available on them. Aims and Objectives: This study was conducted to perform safety surveillance and causality assessment of adverse events following immunization (AEFI) with COVID-19 vaccine. Materials and Methods: This prospective observational study was conducted on healthcare workers who received their first dose of COVISHIELD during first phase of COVID-19 vaccination in January–February 2021 at F.H. Medical College and Hospital, Tundla, Firozabad. Approval for the study was taken from institutional ethical committee. The details of AEFIs were collected and duly noted in standard AEFI case reporting form of Ministry Of Health And Family Welfare, Immunization Division, Govt. of India and reported to District Immunization Officer. Causality assessment was done in accordance with protocol of the World Health Organization. Results: Out of 419 vaccinees, 210 had developed AEFIs, and 527 AEFIs were reported considering the fact that one recipient could have experienced multiple AEFIs. Majority AEFIs were related to general disorders and administration site conditions (67.35%), where fever (28.46%), chills (16.69%),and pain at injection site (15.75%) were more common, followed by musculoskeletal and connective tissue disorders (19.55%) where myalgia (18.03%) was more commonly reported. Out of 527 AEFIs reported, majority (524, 99.43%) showed consistent causal association to immunization and 3 (0.57%) AEFIs showed inconsistent association. AEFIs classified as consistent causal association (524) mostly were vaccine product related reactions (520, 99.23%) and rest (4, 0.76%) were immunization anxiety related reactions. Severity assessment of AEFIs was done using Modified Hartwig and Siegel Severity Scale, out of total 527 AEFIs reported 60.9% were of mild severity and rest 39.1% were categorized as moderate severity. Conclusion: As adverse events post-vaccination with COVISHIELD were mild to moderate in severity and lasted for a short duration, the inconvenience caused by these AEFIs outweigh the protection offered by the vaccination against COVID-19.
  PubDate: 2022-05-03
  DOI: 10.3126/ajms.v13i5.43014
  Issue No: Vol. 13, No. 5 (2022)
Clinical sub typing of newly detected type 2 diabetics on the basis of
pancreatic beta cell function and degree of insulin resistance and their
clinical characterization
- Authors: Avijit Saha
  Pages: 23 - 28
  Abstract: Background: Insulin resistance is a major cause for developing type 2 diabetes but is not synonymous with the type 2 diabetes. Pancreatic beta cell dysfunction probably needs to be sets in for clinical occurrence of type 2 diabetes. So knowledge regarding residual beta cell function and degree of insulin resistance is essential. Aims and Objectives: The objectives are as follows: (1) To estimate degree of insulin resistance (HOMA-IR) and pancreatic beta cell functional capacity (HOMA-B %) among newly detected Type 2 diabetics and (2) to identify different clinical phenotypic presentations of type 2 diabetes on the basis of these parameters. Materials and Methods: This present study was conducted in newly diagnosed type 2 diabeticpatients. After obtaining informed consent, anthropometric and clinical examination was carried out in all patients. Venous blood samples were drawn for fasting plasma glucose,c-peptide,fasting insulin level,HbA1c,lipid profile, etc.HOMA-IR and HOMA-B% were calculated with HOMA 2 calculator. Results: A total 100 newly diagnosed type 2 diabetic patients were studied. About 71% pt of study population had HOMA-B% value below 50% and half of study population had significant amount of insulin resistance. Three distinct clinical phenotypes had identified. Insulin resistance predominant group (30%), beta cell dysfunction predominant group (45%), and both abnormalities coexist group (25%). Conclusion: By the time of diagnosis of Type 2 diabetes, more than two-third study population had <50% residual beta cell function left and more than half had significant degree of insulin resistance. Hence,this functional assessment needs to be done for appropriate antidiabetic drug selection and for identification of different clinical phenotypes.
  PubDate: 2022-05-03
  DOI: 10.3126/ajms.v13i5.44360
  Issue No: Vol. 13, No. 5 (2022)
Assessment of energy expenditure in postpartum women with prior
gestational diabetes mellitus: Subjective versus objective methods
- Authors: Thamudi D Sundarapperuma, Sudharshani Wasalathanthri , Champa J Wijesinghe, Priyadarshika Hettiarachchi
  Pages: 29 - 35
  Abstract: Background: Regular physical activity (PA) attenuates the development of type 2 diabetes mellitus in postpartum women with prior gestational diabetes mellitus (GDM). PA is assessed by calculating the energy expenditure (EE), thus accurate estimation of EE is crucial. International PA Questionnaire (IPAQ) and activity diary are widely used subjective methods while pedometer provides objective evidence of PA and EE. Aims and Objectives: This study aims to compare subjective and objective methods of assessing EE as a measure of PA in postpartum women with a history of GDM. Materials and Methods: Fifty postpartum women who had a history of GDM were advised to maintain activity diaries and pedometer readings for 1 week each month up to 1 year and IPAQ was administered at the end of 6 and 12 months. EE was calculated by all three methods separately and Bland-Altman plots were used to assess the level of agreement between IPAQ and the other tools at 6 and 12 months. Friedman test was performed to compare estimated EE between the three methods. Results: There was a poor agreement between the subjective and objective methods. According to Bland-Altman plot results, the highest mean difference was observed between IPAQ and pedometer at 12 months (mean difference was 75.9). This observation indicated an underestimation of pedometer values at 12 months. EE assessed by two subjective methods were statistically comparable at both time points whereas, EE assessed by pedometer was significantly lower (P<0.017) compared to self-reported tools. Conclusion: Assessment of EE by subjective methods which are based on personal judgment may cause overestimation of PA. In contrast, pedometer readings are likely to underestimate the PA as it only reports kinetics activities. Therefore, a combination of subjective and objective methods is recommended to ameliorate the reliability and validity.
  PubDate: 2022-05-03
  DOI: 10.3126/ajms.v13i5.41342
  Issue No: Vol. 13, No. 5 (2022)
Modified Delphi in adapting a tool to assess the level of knowledge and
practice on adult enteral nutrition therapy among nurses
- Authors: Piyumi L Weerawardhana, Lalitha Meegoda MKD, Sampatha E Goonewardena
  Pages: 36 - 44
  Abstract: Background: Enteral nutrition (EN) is the preferred method of nutritional administration for critically ill patients according to the world’s standards. Nurses have a key role in delivering EN and assessing nurses’ knowledge and practice on this, are crucial for maintaining quality nursing care. Aims and Objectives: This study was to utilize modified Delphi in adapting a tool to assess the level of knowledge and practice on adult EN therapy among nurses in Sri Lanka. Materials and Methods: A three-round modified Delphi technique (DT) was employed in adapting a research tool to assess nurses’ knowledge and practice according to the nursing and EN guidelines in Sri Lanka. The questionnaire included 34 knowledge assessment items and 41 observational items to assess practice. Eight subject experts were purposively selected to rate each item on a 5-point Likert scale under three subheadings. Consensus defined at 80% agreement and mean ≥3. Mean value <3 was considered for suggested modifications. Experts participated in a final meeting in round 3 to finalize the tool. Results: Response rate was 100% throughout the process. During round 1, 13/34 knowledge items were modified, two were removed, and one item was added. In round 2, four items were modified, and one was removed. From the observational items, 40/41 achieved consensus, one was modified, and a new one was added in round one. One was modified in round 2. All achieved consensus by round three. The final tool contained 32 knowledge items and 42 observational items with test-retest reliability correlations ranging from 0.99 to 0.95. Conclusion: Modified DT was appropriate in achieving judgmental validity through experts’ consensus in adapting a research tool to assess nurses’ knowledge and practices on EN therapy for adult critically ill patients in Sri Lanka.
  PubDate: 2022-05-03
  DOI: 10.3126/ajms.v13i5.42806
  Issue No: Vol. 13, No. 5 (2022)
Study of pain scores and need for rescue analgesia with intrathecal
fentanyl as an adjuvant with 0.5% hyperbaric bupivacaine for cesarean
section
- Authors: Thrupthi BP, Nazima Y Memon, Niteen K Nandanwankar, Yennawar SD, Ajay L Jogdand, Juhi P Bagga
  Pages: 45 - 50
  Abstract: Background: Cesarean section contributes to the major part of surgeries taking place in any hospital now a days. Hence, improving anesthesia in cesarean section is of paramount importance. Intrathecal fentanyl can produce rapid, profound analgesia for cesarean section, early labor with minimal side effects. It also has minimal respiratory depressant effect on fetus. Present study was aimed to study pain scores and need for rescue analgesia with intrathecal fentanyl as an adjuvant with 0.5% hyperbaric bupivacaine for cesarean section. Aims and Objectives: Primary Objective was to evaluate intrathecal fentanyl as an adjuvant with 0.5 % hyperbaric Bupivacaine for caesarean section. The secondary objective was to compare onset and duration of sensory and motor blockade as well as to assess pain scores, analgesic requirements and side effects. Materials and Methods: The present study was hospital-based randomized double-blind control study conducted in pregnant women of 18–35 years age, 50–70 kg weight, ASA-II, posted for elective cesarean section. 60 patients were randomly divided into Group I (study group, n=30, receiving 0.5 % hyperbaric bupivacaine 1.6 ml+intrathecal fentanyl 0.4 ml/20 mcg) and Group II (control group, n=30, receiving 0.5% hyperbaric bupivacaine 1.6 ml+0.4 ml normal saline). Results: The difference in mean time for onset of sensory block, onset of motor block, maximum time taken to achieve highest level of sensory analgesia, total duration of motor block, and degree of motor block was statistically insignificant. The difference in mean duration of time to sensory regression was statistically highly significant (P<0.0001). VAS score was used to assess pain postoperatively initially every 5 min then every 30 min up to 5 h. VAS score in post-operative period was less in Group I and difference was statistically significant. Mean Apgar Score at 1 and 5 min were comparable in both the groups with no statistically significant difference. Diclofenac consumption was significantly decreased in Group I as compared to group II. Conclusion: We conclude that the 0.5% hyperbaric Bupivacaine 8 mg with Fentanyl 20 μg is safe, effective, superior for spinal anesthesia, provided more longer duration of analgesia and significantly reduced number of rescue analgesia doses in cesarean section.
  PubDate: 2022-05-03
  DOI: 10.3126/ajms.v13i5.42777
  Issue No: Vol. 13, No. 5 (2022)
A prospective, randomized clinical study for evaluation of pregabalin for
post-operative analgesia in infraumbilical surgeries
- Authors: Mona Bhalavi, Kishore Uikey, Seema Bhalavi, Sonali Tripathi
  Pages: 51 - 56
  Abstract: Background: Preemptive analgesia is about the administration of an analgesic agent before the initiation of noxious stimulus, aiming of preventing sensitization of the neural system to successive stimulus that could intensify pain perception. Pregabalin is derivative of gabapentinoid which exhibits analgesic properties. Aims and Objectives: This clinical study designed to evaluate the effectiveness of pregabalin for post-operative analgesia in infraumbilical surgeries. Materials and Methods: This prospective clinical study was conducted in a medical college hospital of central India after obtaining approval from institutional ethics committee and informed written consent from the selected patients over the period of 1 year. A total of 60 patients between the ages of 20 and 40 years of ASA Grade I/II were randomly assigned into two groups (n=30, each) using an online randomization tool. Patients in Group P received oral Pregabalin 150 mg and Group D received oral Diazepam 10 mg, 1 h before induction of anesthesia. Both the groups uniformly received Tablet Paracetamol 1 gm, 2 h after completion of surgery. Patients experiencing pain with visual analogue scale (VAS) score ≥3, were injected Inj. Tramadol 100 mg, as rescue analgesia. Outcome variables such as need for rescue analgesia, sedation, VAS score, and other adverse events were noted at time intervals of 2, 4, 6, 12, and 24 h. Results: The mean VAS scores in patients of Group P were significantly lower than Group D (P<0.0001), over 24 h of post-operative period. In Group P, rescue analgesic Inj. Tramadol was given after 12.33±3.47 h as compared to 3.47±8.19 h in Group D (P<0.0001) with total need of 133.56±49.27 mg and 210.73±63.35 mg over 24 h in patients of Groups P and D, respectively (P<0.0001). Conclusion: Pregabalin 150 mg in pre-operative period provides superior post-operative analgesia and considerably reduces need of rescue analgesia postoperatively.
  PubDate: 2022-05-03
  DOI: 10.3126/ajms.v13i5.42429
  Issue No: Vol. 13, No. 5 (2022)
Comparison of intranasal dexmedetomidine and oral midazolam as
premedication for cochlear implant surgery in children
- Authors: Ankit Agrawal, Anuruddha Singh, Arpit Agrawal
  Pages: 57 - 61
  Abstract: Background: Children undergoing surgical procedures can experience significant anxiety and distress during the perioperative period. The use of sedative premedication may help to reduce anxiety, minimize the emotional trauma, and facilitate a smooth induction of anesthesia. Midazolam is most commonly used as a premedication agent in children. Dexmedetomidine is a highly selective alpha-2 adrenoreceptor agonist that provides sedation, anxiolysis, and analgesic effects without causing respiratory depression. Aims and Objectives: The aim of the study was to compare intranasally administered dexmedetomidine and oral midazolam for premedication in pediatric patients undergoing cochlear implant surgeries. Materials and Methods: This prospective randomized controlled study included 60 ASA Grade I and II patients between 1 and 6 years of age who underwent cochlear implant surgeries under general anesthesia. Patients were divided into two groups. Group A received 1μg/kg intranasal dexmedetomidine and Group B patients received 0.5 mg/kg oral midazolam 45 min before induction. The pediatric separation anxiety was assessed using the pediatric separation anxiety scale (PSAS) while shifting the patient to operating room (OR) and mask acceptance was assessed by the attending anesthesiologist using mask acceptance scale (MAS) in OR who is blinded to the drug given. Heart rate (HR) and oxygen saturation were monitored till the end of procedure was noted on a pre-structured proforma. Results: The mean PSAS in intranasal dexmedetomidine group was 1.00±0.00, while in the oral midazolam group was 2.10±0.31 (P=0.000). The mean MAS in intranasal dexmedetomidine group was 1.00±0.00, while in the oral midazolam group was 2.13±0.35 (P=0.000). Mean HR (P>0.05), systolic blood pressure (P>0.05), and diastolic blood pressure (P>0.05) were comparable between both the groups. There was a statistically significant association seen between sedation grade and the groups (P=0.000), showing that groups are dependent on the sedation group. There was a statistically significant association seen between wake up behavior grade and the groups (P=0.000), showing that groups are dependent on the wake up behavior grade. Conclusion: Intranasal dexmedetomidine is an effective and safe alternative for premedication in view of parental separation, mask acceptance, hemodynamic stability, and sedation for the children undergoing cochlear implant surgeries under general anesthesia.
  PubDate: 2022-05-03
  DOI: 10.3126/ajms.v13i5.42299
  Issue No: Vol. 13, No. 5 (2022)
Comparison of clinical efficacy of intrathecal ropivacaine versus
ropivacaine with dexmedetomidine in patient posted for infraumbilical
surgeries under spinal anesthesia
- Authors: Isha Yadav, Ankita Aggarwal, Mahima lakhanpal, Himanshu Nirvan
  Pages: 62 - 68
  Abstract: Background: Data related to clinical efficacy of intrathecal dexmedetomidine as an adjuvant to isobaric ropivacaine in spinal anesthesia were found to be inadequate, but the efficacy of newer molecules as an adjuvant is investigated constantly. Considering the favorable profile of dexmedetomidine, it could have a potential role as an adjuvant to ropivacaine. Aims and Objectives: The aim of the study was to evaluate the benefits of adding intrathecal dexmedetomidine as an adjunctive along with ropivacaine. The aim of the study was to assess and compare the safety and efficacy, post-operative analgesia, complications, duration of analgesia, and time of rescue analgesia for intrathecal ropivacaine versus a combination of intrathecal ropivacaine with dexmedetomidine. Materials and Methods: An observational study was carried out in 80 patients of either sex between 25 and 60 years of age, ASA Grade 1 and 2, undergoing elective abdominal, and lower limb surgeries. Subjects selected as per set inclusion/exclusion criteria and divided into two groups for spinal anesthesia. Group A: 3 ml of intrathecal 0.75% isobaric ropivacaine with 0.5 ml of normal saline. Group B: 3 ml of intrathecal 0.75% isobaric ropivacaine with 5 mcg preservative free dexmedetomidine in 0.5 ml of normal saline. Vital parameters were noted at 0 min, 1 min, 2 min, 5 min, 10 min, and thereafter every 15 min, till the surgery continued. Onset and the time for maximum sensory blockade were assessed and VAS scoring was done every 10 min till 30 min and thereafter every 15 min. The duration of effective analgesia was recorded along with the duration of sensory regression to S1, and time for administration of rescue analgesia was noted. Results: The combination of ropivacaine with dexmedetomidine was statistically found to be efficacious when compared to ropivacaine alone, as evidenced by statistically significant differences (P<0.05) in VAS scores at 80, 180, and 360 min and duration of regression to S1 level. The differences in time for rescue analgesia were also statistically significant (P<0.05), further proving the advantage for longer lasting analgesia without any additional adverse effects. Conclusion: 5 mcg dexmedetomidine is an attractive alternative as an adjuvant to spinal ropivacaine in surgical procedures, as opposed to ropivacaine alone, without any additional adverse effects.
  PubDate: 2022-05-03
  DOI: 10.3126/ajms.v13i5.42270
  Issue No: Vol. 13, No. 5 (2022)
Neonatal outcome in pregnancies complicated by Gestational Diabetes
Mellitus in a tertiary care hospital from South India
- Authors: Shrikant Jamdade, Nibedita Mitra, Senthilkumar V, Kavitha G, Nithya M
  Pages: 69 - 74
  Abstract: Background: Affecting 537 million adults worldwide and counting, diabetes is spiraling out of control. Historically pregnancies complicated by abnormal glycemic control are associated with various neonatal complications, increased morbidity and mortality. Majority of abnormal glycemic control in pregnancy is attributed to Gestational Diabetes Mellitus (GDM) rather than pregestational Diabetes Mellitus. 21 million live births (1 in 6) were affected by hyperglycemia during pregnancy worldwide in 2021, approximately 80% of which is attributed to GDM. With disease burden increasing at an alarming rate a hospital-based descriptive study was conducted to observe neonatal outcome in pregnancies complicated by GDM. Aims and Objectives: The present study was undertaken to observe neonatal outcome, in pregnancies complicated by GDM in terms of neonatal mortality and neonatal complications, in the study hospital. Materials and Methods: 115 mothers diagnosed to have GDM and their infants were enrolled in the study. Maternal antenatal records and indoor case sheets were used to collect data regarding maternal medical profile and any associated obstetric complications. Neonatal indoor case sheets were reviewed to collect data regarding gestational age, birth weight, and gender. Neonatal complications and mortality if any were recorded. Descriptive analysis was done using data collected. Results: Out of 115 infants 60 (52.2%) were female and 55 (47.8%) were male, 108 (93.9%) were full term and 7 (6.1%) were preterm. 93 (80.9%) infants were appropriate for gestational age, 15 (13.0%) were small for gestational age, and 7 (6.1%) were large for gestational age. Four (3.4%) infants had birth weight more than 4000 g. Neonatal complications were noted in 26 (22.6%) infants, most common being neonatal hyperbilirubinemia (n=14) (12.2%). Other neonatal complications observed were respiratory distress (n=5) (4.3%), perinatal asphyxia (n=3) (2.6%), hypoglycemia (n=2) (1.7%), meconium aspiration syndrome (n=1) (0.9%), and neonatal convulsions (n=1) (0.9%). Cardiac malformations noted were ventricular septal defect (n=1) (0.9%) and atrial septal defect (n=1) (0.9%). There was no neonatal mortality noted in the study. Conclusion: In our study, we observed a better neonatal outcome in terms of neonatal mortality and morbidity as compared to that noted historically in the literature. Early detection and meticulous maternal diabetes management is associated with better neonatal outcome as observed in this study. This observation is also well supported in the literature along with the fact that, untreated GDM is associated with significant neonatal morbidity.
  PubDate: 2022-05-03
  DOI: 10.3126/ajms.v13i5.43550
  Issue No: Vol. 13, No. 5 (2022)
Cadaver as the first silent medical teacher: Exploring bioethical
perceptions of department of anatomy
- Authors: Surajit Kundu, Anil R Sherke, Richa Gurudiwan
  Pages: 75 - 84
  Abstract: Background: Department of Anatomy with its time honored and integral essence, human cadaveric dissection has been trying to serve the medical profession since the inception of medicine. Every human cadaver who goes under the knife of medical student during anatomical dissection deserves special treatment and utmost respect. But unfortunately, probably the hidden curriculum of bioethical sentiments of the body donor and the human cadaver have been noted to become extinct from medical profession, until recently with the introduction of the new competency based medical education in India. Aims and Objectives: The present study attempts to dig out the noble practices followed in various medical schools to ensure the human cadaver gets the rightful respect and dignity. Our literature review reflects the practice of students’ conduct and habits on the 1st day of dissection. We emphasize guidelines that may be sincerely recommended to medical schools to ensure respectful humanity and honor towards the human cadavers. Materials and Methods: The psycho-social attitudes of MBBS students has been attempted to learn by distributing questionnaire to the 2019 batch MBBS students (n=60) of Late Shri Lakhiram Agrawal Memorial Government Medical College Raigarh (CG) during the foundation course (first 1 month of 1st year curriculum) and on their first encounter with the cadaver. Results: About 95.4% and 57.5% of students showed positive and negative perceptions. The religious beliefs and emotional attachments with the cadaver were noted to be as 23.33% and 76.11%, respectively. The sentiments included cognitive, affective, moral, and behavioral. Conclusion: The article attempts to focus the noble endeavor of the Cadaver as the first silent medical teacher who wishes to enlighten the pure minds of medical students with knowledge and empathy to be shown towards the patients. Based on the emotional observations made from the medical students on their first encounter with the cadaver, the present study anastomoses science and humanity with care, compassion, and dignity.
  PubDate: 2022-05-03
  DOI: 10.3126/ajms.v13i5.39305
  Issue No: Vol. 13, No. 5 (2022)
Evaluation of normal distribution of palpebral fissure among the medical
and paramedical students of Eastern Nepal
- Authors: Surendra Kumar Sah, Deepak Chaudhary, Subrato Ghosh, Amit Kumar Shah
  Pages: 85 - 88
  Abstract: Background: The palpebral fissure (PF) is the space between the upper and lower eyelids when the eye is open. The bilateral orbital region which is located in the face acts as one of the important determinants in the perception of facial attractiveness, youthfulness, and health conditions of the individuals. The PF dimensions may get altered in cases of facial deformities and road traffic traumas. Aims and Objectives: The aim of this study was to analyze the mode of distribution of PF dimensions in medical and paramedical students in correlation with gender. Materials and Methods: The study was a cross-sectional study conducted in the duration of August 2021–November 2021 including the sample of 300 medical and paramedical students in an equal number of male and female of age group 16–22 years from Nobel Medical College Teaching Hospital, Biratnagar, Nepal. We measured the dimensions of PF during the normal gaze. The data analysis was done using the SPSS version 16. Results: The mean length of PF (LPF) in males and females was 23.24 mm and 22.72 mm, respectively. The mean height of PF (HPF) in male and female was 8.52 mm and 8.60 mm, respectively. The difference between males and females LPF and HPF was significant
  (<0.05). The mean PF index (PFI) in male and female subjects was, respectively, 37.20 and 38.68 which were statistically significant. Conclusion: It was found that the LPF and HPF were more in males and PFI was slightly more in females than the male which confirms
  the sexual dimorphism. The data obtained will be helpful in the esthetic consideration of the student’spersonality as well.
  PubDate: 2022-05-03
  DOI: 10.3126/ajms.v13i5.42566
  Issue No: Vol. 13, No. 5 (2022)
Height estimation of an individual from forearm length in medical students
- Authors: Kana Bal, Chiranjib Bapuli
  Pages: 89 - 93
  Abstract: Background: Height is an important parameter of human in anthropology and forensic medicine. We can measure the height of an individual from forearm length (FAL). In this study, we found the relationship between FAL and height in medical students. Aims and Objective: The objective of the study was to find co-relation between FAL and height of the individuals (male and female medical students) and to obtain regression formula to determine the height from FAL. Materials and Methods: Height and FALs were measured in 200 medical students of 17–22 years age (100 males and 100 females) of N.R.S Medical College, Kolkata. For finding, the relationship between height and FAL linear regression analysis was used. Results: In our study, average height of the female students was 158.64±5.28 cm, whereas in male students average height was 168.97±6.33 cm. Mean FAL has been 26.63±1.72 and 23.72±1.44 cm, respectively, in case of male and female students. Difference of the mean height and mean length of forearm values between female and male students was statistically significant. The correlation coefficient (r) between height and FAL of dominant side has been, respectively, +0.93, +0.96, and +0.97 in case of male, female, and total students. According to the linear regression, there was a relation between height and FAL. Conclusion: From our study, it is evident that we may estimate the height of a person from measurement of FAL. In future studies may be carried out to estimate height of an individual from other body parameters also.
  PubDate: 2022-05-03
  DOI: 10.3126/ajms.v13i5.41314
  Issue No: Vol. 13, No. 5 (2022)
Clinical profile, management, and outcome of obstructive jaundice patient
at a tertiary care center: A prospective study
- Authors: Gulab Dhar Yadav, Anju Yadav, Shraddha Verma, Mohammad Tahir Hussain
  Pages: 94 - 99
  Abstract: Background: There are various causes of obstructive jaundice, choledocholithiasis is the commonest cause. Patients with obstructive jaundice need early diagnosis to established level and nature of obstruction in biliary system. The history and clinical examination in arriving at a correct pre-operative diagnosis in almost always possible today because of advances in imaging techniques over the decades. Presents study attempts to determine the various causes, age and sex pattern in Extra Hepatic obstructive jaundice. Aims and Objectives: The aim of the study was to study clinical profile, management, and outcome of obstructive jaundice, patient at a tertiary care center: A prospective study. Materials and Methods: The present hospital based prospective interventional study was conducted on patients with obstructive jaundice, those were admitted in the Department of General Surgery at GSVM Medical College Kanpur, patients of age more than 12 years both sex after obtaining the consent form the patient or their relatives were studied during the period of study from January 2020 to October 2021. Results: Of the 50 patients; 29 (58%) were female and 21 (42%) were male, their mean age being 51.10 years. Malignant obstructive jaundice was seen in 19 (38%) patients while 31 (62%) had benign etiology. Amongst the obstructive jaundice cases; pain in abdomen (100%) was commonest symptoms and icterus (100%) was the most common sign. The most common malignancy was Carcinoma (Ca) of the head of pancreas 09 (18%) followed by distal common bile duct (CBD) cholangiocarcinoma 04 (08%), and hilar cholangiocarcinoma 03 (06%). Choledocholithiasis 25 (50%) was the most common benign cause followed by benign stricture of common bile duct 03 (06%). Conclusion: Obstructive jaundice is one of the common causes of surgically amenable jaundice. Its etiology is varied and diagnosis usually depends on appropriate imaging. Proper diagnosis and treatment is necessary as delay in the diagnosis may cause irreversible pathological changes causing increased morbidity and mortality.
  PubDate: 2022-05-03
  DOI: 10.3126/ajms.v13i5.42527
  Issue No: Vol. 13, No. 5 (2022)
Evaluation of Inflammatory markers in different stages of Chronic Renal
Disease
- Authors: Farha Khan, Sangeeta Kapoor, Jyoti Rana, Saba Khan
  Pages: 100 - 107
  Abstract: Background: Chronic kidney disease (CKD) refers to a long-term loss of kidney function. The progression of CKD leads to the damage of other organs including cardiovascular disease which increased the risk of mortality. Early detection of kidney failure can slow down the end-stage renal disease. Aims and Objectives: To estimate the inflammatory marker Adenosine deaminase (ADA) activity in different stages of CKD. To correlate the level of ADA activity with Serum Creatinine with different stages of CKD on the basis of estimated glomerular filtration rate (eGFR). Materials and Methods: The participants having age more than 18 and <60 years having CKD have been enrolled as a study group. CKD was confirmed by calculating eGFR using Cockcroft-Gault equation, plasma creatinine estimation done in all the patients. This study was approved by the Ethical Committee of TMMC and RC. Results: It is observed that the incidence of CKD reaches its maximum strength during middle age. 28% of the young patients, i.e., 45 years of age or younger at the time of CKD, had increased level of ADA. Serum levels of ADA, Creatinine were higher among participants with lower level of eGFR. Inflammation was higher among those with lower eGFR. All biochemical parameter (ADA, CRP, ESR) shows the negative correlation with eGFR. eGFR shows a negative highly significant correlation withESR with a correlation coefficient of r=−4.702 (P<0.001). Conclusion: With the progression of Kidney disease (CKD stages 1–5) it comes to significantly increase of inflammatory markers as decrease in the eGFR with statistical significance. Inflammatory Biomarkers were inversely associated with the measure of kidney function. It is clear that a single indicator of renal function is not sufficient in evaluating the kidney disease stage.
  PubDate: 2022-05-03
  DOI: 10.3126/ajms.v13i5.40454
  Issue No: Vol. 13, No. 5 (2022)
Study of estrogen receptor, progesterone receptor, and HER-2/neu status in
breast carcinoma
- Authors: Rishi Kumar Sherchan, Pradeep Ghimire, Ashbin Lamsal
  Pages: 108 - 112
  Abstract: Background: Breast cancer treatment depends mainly on hormone receptors (estrogen and PRs) and human epidermal growth factor receptor-2 (HER2)/neu profile. These receptor analyzes determine the patient’s prognosis, treatment, and outcome. Aims and Objectives: The main objective of this study was to correlate the histologic grade of breast carcinoma with hormone receptors and HER2/neu status. Materials and Methods: This is a retrospective analysis of 342 patients treated from January 2016 to December 2021 at Manipal Teaching Hospital, Pokhara, Nepal to determine hormone receptors and HER2/neu status in breast carcinoma. Modified radical mastectomy, breast-conserving surgery, toilet mastectomy, and excisional biopsies were included for statistical correlation between hormone receptors, HER2/neu, histologic grade, and lymph node status. Results: The mean age of the patients was 48.43±9.4 years (29–71). Of the 342 patients, 334 (97.7%) were female and 8 (2.3%) were male. Left breast carcinoma was 5.3% more common than right breast carcinoma. Among them, 34 (9.9%), 245 (71.6%), and 63 (18.4%) were grade I, II, and III, respectively. Grade II were the most common cancer. The smallest tumor size was 0.5 cm and the largest tumor size was 14 cm. Lymph node involvement was 226 (66.1%). The most common histology was invasive ductal carcinoma with 282 (82.5%), lobular carcinoma with 47 (13.8%), medullary carcinoma with 9 (2.6%), and mucinous carcinoma with 4 (1.2%). Immunohistochemical analysis of all breast cancer patients in the present study revealed ER 175 (51.2.7%), PR 146 (42.7%), and HER2/neu 93 (27.2%). Of all male patients, ER was 100% positive, PR was 75% positive, and HER2/neu was 25% positive. According to grading, ER was seen positive in 23 (13.1%) in grade I, 112 (64%) in grade II, and 40 (22.8.1%) in grade III carcinoma (P<0.05). Similarly, PR was 19 (13.1%) in grade I, 95(65.9%) in grade II, and 30 (20.8%) in grade III carcinomas (P<0.05). Moreover, Her/2-neu was 7 (7.5%) in grade I, 63 (67.3%) in grade II, and 23 (24.7%) in grade III carcinomas (P<0.05). In HER2/neu positive cases, it was observed that the positive expression of estrogen receptor (ER) was high as compared to PR. Conclusion: ERs, PRs, and HER2/neu are the most important factors that determine the best treatment, prognosis, and outcome in breast carcinoma.
  PubDate: 2022-05-03
  DOI: 10.3126/ajms.v13i5.42331
  Issue No: Vol. 13, No. 5 (2022)
Assessment of carcinoembryonic antigen as a prognostic marker in ovarian
malignancies treated in a rural hospital of West Bengal
- Authors: Phalguni Chakrabarti, Krishnendu Layek, Debasmita Bandyopadhyay, Sanghamitra Chakraborty, Ayesha Hasan, Pinaki Sarkar
  Pages: 113 - 118
  Abstract: Background: Ovarian neoplasms are the second most common cause of gynecological malignancy both worldwide as well as in India. Innocuous clinical presentation and late diagnosis contribute to the mortality toll of this neoplasm. Thus, early diagnosis remains the cornerstone to increase the survival rate of ovarian neoplasms. Though, cancer antigen 125 (CA-125) is a time-tested marker for ovarian neoplasm diagnosis yet its increment in benign gynecological conditions questions its own diagnostic specificity. Carcinoembryonic antigen (CEA), the conventional marker for colorectal cancer detection, is found to be associated with epithelial ovarian cancer. Aims and Objectives: This study was aimed to find the efficacy of CEA along with CA-125 in the early detection of ovarian neoplasm and predicting the outcome. Materials and Methods: This hospital-based longitudinal study was conducted in the Biochemistry department of Bankura Sammilani Medical College. Established cases of ovarian neoplasm were recruited as study population using pre-defined inclusion and exclusion criteria. Serum CEA and CA-125 were estimated at the time of diagnosis, 6 weeks, 6 months, and 12 months after surgery. Results: There was no significant difference between the median concentration of CEA among the four phases of treatment. Serum CEA was positively correlated to CA-125 during all phases of treatment (Ρ=0.653, P=0.000). The binary logistic regression revealed that CEA (odds ratio=1.2, 0.83–1.69) had higher chances to be associated with ovarian stages associated with cancers beyond Stage IC. CEA had a lower sensitivity and specificity in comparison to CA-125. Conclusion: This study suggested CEA, a theranostic marker, can supplement the present biochemical diagnostic modalities to improve diagnostic and prognostic efficacy cost-effectively.
  PubDate: 2022-05-03
  DOI: 10.3126/ajms.v13i5.41814
  Issue No: Vol. 13, No. 5 (2022)
Analysis of cephalosporins available in India: A pharmacoeconomic
perspective
- Authors: Ritesh Churihar, Hemant Tanwani, Kamayani Gupta
  Pages: 119 - 124
  Abstract: Background: Bacterial infections are one of the most common causes of morbidity and mortality in community and hospital settings. The acceptance of the treatment imposes heavy economic burden on the patients. Due to improper drug policy, different costly preparations of the same brand are ordered and tendered, which pose a sheer wastage of money, ultimately causing burden on tax payers. Aims and Objectives: The present study was planned to evaluate and compare the costs of different brands of various generations of cephalosporin which may be generic or commercial in nature. Materials and Methods: We selected commonly used drugs from different generations of cephalosporins. Cost of drugs (may be generic or commercial or of different formulations) was obtained from latest periodic manuals of Indian Drug Review (INR) and drug today and was analyzed for cost ratio, cost range, and percentage difference among brands from different pharmaceutical companies for oral and parental forms. Correlation among price variations between them was observed by data comparison. Results: Cephalosporins were analyzed for the differences in prices. We not only found wide variation between the cost of generic and commercial preparations but also very wide price range and ratio among the same products from reputed to medium companies. Conclusions: Our study has indicated about the wide differences in the cost of different cephalosporins which are the most commonly prescribed group of antimicrobials. If hospitals across India adopt uniform policy of prescribing cost-effective preparations (brands/generic) only, then the unnecessary economic burden can be significantly reduced.
  PubDate: 2022-05-03
  DOI: 10.3126/ajms.v13i5.41249
  Issue No: Vol. 13, No. 5 (2022)
Clinical profile and dermoscopic findings in alopecia areata
- Authors: Aswin Sreevas O, Mary Vineetha, Aswini R
  Pages: 125 - 130
  Abstract: Background: Alopecia areata (AA) is a common, chronic, and inflammatory disease that causes non-scarring hair loss. Dermoscopy can be used not only to diagnose AA and differentiate other causes of patchy alopecia but can also be a useful tool in assessing the severity of the disease. Aim and Objectives: The aim of the study was to study the clinical profile, various dermoscopic findings, and correlation between different dermoscopic findings and disease severity of AA. Materials and Methods: It was a cross-sectional descriptive study including clinically diagnosed cases of AA attending the outpatient department of dermatology. A detailed history and clinical examination was done along with dermoscopy of lesion and the patterns were noted. Results: A total of 117 patients were included in study. About 44% patients had mild AA, 48% had moderate, and 8% had severe alopecia. Patients with atopy and family history had an early onset of disease. Family history, presence of diabetic mellitus, and nail changes were associated with severe disease. The most common dermoscopic finding noted in our study was black dots followed by short vellus hairs, broken hairs, yellow dots, and tapering hairs. Yellow dots correlated positively with severity of AA while black dots, broken hairs, and short vellus hairs correlated negatively with the severity of AA. There was no relation between tapering hairs and severity of AA. Conclusion: AA is a disease of younger age. Black dots are the most common dermoscopic findings and along with this other patterns can be useful in diagnosis and assessment of severity of disease.
  PubDate: 2022-05-03
  DOI: 10.3126/ajms.v13i5.42306
  Issue No: Vol. 13, No. 5 (2022)
Study of APACHE II score and National Institutes of Health Stroke Scale as
prognostic indicators in cerebrovascular accidents patients admitted in a
tertiary care center, Rewa
- Authors: Saritesh Kumar Thakur, Pallavi Indurkar, Dinesh Kumar Malviya, Manoj Indurkar
  Pages: 131 - 135
  Abstract: Background: Stroke is the 2nd largest cause of mortality world over. In the intensive care unit (ICU), severity scales are crucial adjuncts of treatment for anticipating patient outcomes, comparing quality of care, and stratification for clinical studies. They are an important aspect of making better health-care judgments and identifying people with unusual outcomes. This study was conducted to assess and compare Acute Physiology and Chronic Health Evaluation II (APACHE II) score and National Institutes of Health Stroke Scale (NIHSS) score as predictors of mortality in cerebrovascular accident (CVA) patients admitted in medical intensive care unit (ICU) of tertiary care center, Rewa. Aims and Objectives: To evaluate APACHE II score, NIHSS score and APACHE II + NIHSS score as a predictor of short term mortality in CVA patients. Materials and Methods: This was a cross-sectional, analytical study conducted in the Department of Medicine, Sanjay Gandhi Memorial Hospital, associated with Shyam Shah Medical College, Rewa (M.P), between January 2020 and June 2021. The APACHE II score, NIHSS score, and APACHE II+NIHSS scores were calculated for each patient on day of admission and patients were followed up for a maximum period of 7 days. The area under receiver operating characteristic (ROC) curve was used to measure the ability of these scoring systems to forecast the prognosis, to find the best dividing value. Results: Out of 154 patients of CVA, 102 were male and 52 were female. In both sexes, the highest frequency of CVA was seen in those over 55 years of age. The mean age of the participants in the study was 62.70±12.62 years while it was 61.98±12.83 years for males and 64.13±12.19 years for females. The mean APACHE II score in death group was 29.45±10.095, mean NIHSS score in death group was 32.45±6.486, and the mean of both scores combined in death group was 61.91±14.017 and the mean of APACHE II score in survival group was 12.92±6.478, mean NIHSS score in survival group was 14.09±8.099, and the mean of both scores combined in survival group was 27.76±14.090. The APACHE II score had an area under the curve (AUC) of 0.919 which is slightly more than the NIHSS score which had the AUC of 0.913 and the sum of the two scores had the highest area under the ROC curve which is 0.947. According to Youden’s index, the dividing value for the APACHE II score is 21, the NIHSS score is 22, and APACHE II+NIHSS score was 42. Conclusions: Application of APACHE II and NIHSS scores provides an objective method to decide prognosis and plan management of CVA patients. It also helps in deciding whether the patient needs to manage in neurology ward or ICU depending on the dividing value. Both the scores have good ability to predict the short-term prognosis of CVA patients and the combination of these two can provide an even better measure of mortality.
  PubDate: 2022-05-03
  DOI: 10.3126/ajms.v13i5.43985
  Issue No: Vol. 13, No. 5 (2022)
Reliability of Typhidot-M in diagnosis of typhoid fever in children
- Authors: Nithya M, Shrikant Jamdade, Kannan N, Nibedita Mitra
  Pages: 136 - 139
  Abstract: Background: Typhoid fever continues to be endemic and a major cause of mortality and morbidity in the developing countries. Many times, it presents a diagnostic challenge to treating physicians due to overlapping clinical features with other common causes of acute fever. A rapid and reliable laboratory test would be of great help to clinicians for early diagnosis and appropriate treatment of typhoid fever. Aims and Objectives: The present study was conducted to assess the reliability of Typhidot-M in diagnosis of typhoid fever. Materials and Methods: A total of 203 children with clinical features consistent with typhoid fever were enrolled in the study. Blood culture, Typhidot-M, and Widal test were performed. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for Typhidot-M and Widal test in comparison with blood culture as reference standard. Results: Out of 203 patients, 30 (14.8%) were blood culture positive. One hundred and six patients were Typhidot-M positive and 97 were negative. Typhidot-M had a sensitivity of 93.3%, specificity of 54.9%, and PPV and NPV of 26.4% and 97.9%, respectively. Conclusion: Typhidot-M is a sensitive test for early diagnosis of typhoid fever. However due to low specificity, positive results should be correlated with clinical picture and other possible diagnoses.
  PubDate: 2022-05-03
  DOI: 10.3126/ajms.v13i5.42544
  Issue No: Vol. 13, No. 5 (2022)
Effectiveness of in-house developed Sandwich ELISA for antigen detection
of tubercular antigen in resource constraint setting
- Authors: Uditkumar Agrawal, Vaibhav Agrawal, Shikha Agrawal, Swapnil Patond, Sanjay Agrawal
  Pages: 140 - 144
  Abstract: Background: Around 26% of World’s tuberculosis (TB) cases are in India. In resource constrained settings, it is difficult to use diagnostic tests such as nucleic acid amplification technique and mycobacterial culture due to their complexity and expensiveness. Developing an assay using polyclonal antibody may help to solve this problem. Aims and Objectives: On the basis of this, we worked to detect tubercular antigen by developing Sandwich ELISA from the serum of TB patients. Materials and Methods: For this study, 50 cases, 50 disease controls, and 30 healthy control subjects were taken. Commercially available reagents were used for the development of Sandwich ELISA. The data were statistically analyzed with the help of software SPSS version 16.0. Results: Our effectively developed test had 82% area under the ROC curve. About 81% (n=35) patients of pulmonary TB cases with non-HIV infection detected by our Sandwich ELISA and 57% cases with the coinfection of HIV-TB. Developed test had 70.91% positive predictive value and 75.56% negative predictive value. Conclusion: We successfully developed Sandwich ELISA for tubercular antigen detection and to increase the specificity of the Sandwich ELISA, as per the WHO guidelines, further work is needed for the detection of tubercular antigen.
  PubDate: 2022-05-03
  DOI: 10.3126/ajms.v13i5.42966
  Issue No: Vol. 13, No. 5 (2022)
Development and validation of an in-house handheld ELISA kit to detect
glycosylated hemoglobin in human whole blood
- Authors: Nagababu Pyadala, Prudhvi Chand M, Ravi Kumar BN, Manno N Konyak, Ratna Giri Polvarapu
  Pages: 145 - 153
  Abstract: Background: Diabetes mellitus (DM) is known as one the oldest disease known to a human being and it is defined as a group of metabolic disorders characterized by the presence of hyperglycemia. Aims and Objectives: The present study describes the development and evaluation of a cost-effective and straightforward in-house handheld enzyme-linked immunosorbent assay (ELISA) kit for the determination of HbA1c in human whole blood of diabetic patients and is suitable for resource-poor settings. Materials and Methods: A total of 1056 specimens were collected for assay validation purposes. To check the proficiency of our diagnostic strategy, we compared our test results with high-performance liquid chromatography (HPLC) and a commercially available ELISA kit for HbA1c. The Institutional Ethical Committee approved this study (IEC). SPSS 16 statistical software analyzed all the data. The correlation regression was done to compare the assay. The level of significance of this study was P<0.001. Results: The sensitivity, specificity, and efficiency of the inhouse HbA1c ELISA kit range from 98.8%, 100%, and 99.24%. Conclusion: The newly developed in-house handheld HbA1c ELISA test kit is not only cost-effective, accurate, and straightforward but also gives good correlation with optimized methods such as HPLC and commercially available techniques in deciding the glycemic status of patients. Therefore, highly recommended for use in resource-poor settings in the management and diagnosis of DM.
  PubDate: 2022-05-03
  DOI: 10.3126/ajms.v13i5.42905
  Issue No: Vol. 13, No. 5 (2022)
Role of diagnostic laparoscopy in suspected abdominal tuberculosis
- Authors: Ashwani Gupta, Nikhil Prasad, Vaishali Shirale, Neha Dubey, Indu Bhushan Dubey
  Pages: 154 - 160
  Abstract: Background: The difficulty in confirming the diagnosis, morbidity and mortality associated with laparotomy in patients with abdominal Tuberculosis (TB) has generated interest in laparoscopy to obtain specimens for histological and microbiological assessment. Aims and Objectives: Difficulty in sample procurement, paucibacillary load and non-specific clinical, biochemical, and radiological features makes early diagnosis difficult in abdominal TB. Diagnostic laparoscopy with peritoneal biopsy can provide rapid and correct diagnosis of abdominal TB and reduce significant morbidity and mortality. Materials and Methods: Laparoscopy with umbilical port enabled direct inspection of peritoneum, intra-abdominal organs and facilitated obtaining biopsy specimens, cultures, and aspiration. Results: Diagnostic laparoscopy has an important role not only in diagnosing abdominal TB, but also to rule out TB in certain cases. In our study, mesenteric lymphadenopathy was present in 85% of cases, tubercles in 63% and adhesions in 73%. An alternative diagnosis was established in 6 suspected abdominal TB patients (20%) who were microbiologically confirmed TB negative. Conclusion: The study showed the feasibility of diagnostic laparoscopy in diagnosis of abdominal TB by sampling macroscopically visible pathological tissue with a low complication and conversion rate in most patients with suspected TB, and also providing an alternative diagnosis.
  PubDate: 2022-05-03
  DOI: 10.3126/ajms.v13i5.42908
  Issue No: Vol. 13, No. 5 (2022)
Bacteriological profile and antibiotics sensitivity patterns among
neonates admitted at Birat Medical College Teaching Hospital
- Authors: Ramesh Yadav, Hemsagar Rimal, Santosh Upadhyay Kafle, Anu Budhathoki, Anisha Sha
  Pages: 161 - 166
  Abstract: Background: Neonatal sepsis still remains serious and potentially life-threatening events with a mortality rate of up to 50%. The current practice of starting empirical antibiotic therapy in all neonates showing infection-like symptoms results in their exposure to adverse drug effects, nosocomial complications, and in the emergence of resistant strains. The antibiotic sensitivity pattern of organisms is changing very rapidly over a short period which is varying from country to country, one place to another, and one institute to another. Therefore, periodic evaluation of sensitivity patterns is essential for rational and appropriate use of antibiotics. Aims and Objectives: This study aims to see bacteriological profile and their antibiotics sensitivity among the sepsis suspected neonates at the neonatal intensive care unit of Birat Medical College Teaching Hospital (BMCTH). Materials and Methods: It was a cross-sectional descriptive study from July 21, 2021, to December 21, 2021. Sample size of 138 was included in the study. Neonates were selected by non-probability consecutive sampling techniques. Neonatal sepsis suspected neonates and plan to treat with injectable antibiotics by the treating pediatrician were included in the study. All patients included were started on empirical antibiotics after drawing samples for blood cultures and CRP along with other investigations. Bacteriological profile and their sensitivity to different antibiotics were collected from blood culture reports. Data collection was done using a specifically designed questionnaire. The descriptive and inferential statistics were used for data analysis. The test of significance was done by the Chi-square test. P<0.05 was considered statistically significant. Results: Among the 46 blood culture-proven sepsis, the most common organism isolated was Staphylococcus aureus which was 33 (71.7%). Among the isolated S. aureus, 100% were sensitive to colistin sulfate and injectable linezolid, 93.1% sensitive to injectable meropenem, 85.7% sensitive to injectable piperacillin and tazobactam combination, 83.3% sensitive to injectable vancomycin, and 85.7% sensitive to injectable amikacin but only 40.7% to injectable cefotaxime. Isolated Acinetobacter species were found 100% sensitive to colistin sulfate and meropenem, and 80% sensitive to cefotaxime and amikacin but only 66.7% sensitive to injectable piperacillin and tazobactam combination. Only one neonate had Klebsiella isolated in blood culture which was 100% resistant to injectable cefotaxime but was sensitive 100% to Meropenem, piperacillin-tazobactam, and amikacin. Isolated Enterococcus species were 100% sensitive to piperacillin-tazobactam combination, meropenem, and imipenem but only 66.7% sensitive to injectable cefotaxime. Conclusion: Gram-positive isolates were the predominant pathogens among enrolled neonatal sepsis suspected neonates at Birat medical college teaching hospital (BMCTH). Based on our findings, a combination of cefotaxime and amikacin can be used as first-line therapy. However, cefotaxime only had moderate sensitivity, so change to piperacillin-tazobactam and vancomycin or linezolid as second-line therapy can be considered early in case of no improvement or deterioration, or combination of vancomycin and meropenem as third line would be the appropriate empirical therapy at BMCTH. However, the use of the broad-spectrum antibiotics as empirical therapy should be evaluated in the long run and should be used cautiously and modified to narrow spectrum antibiotics, as guided by the culture and susceptibility report at the earliest possible.
  PubDate: 2022-05-03
  DOI: 10.3126/ajms.v13i5.41107
  Issue No: Vol. 13, No. 5 (2022)
Prevalence of Helicobacter Pylori infection in children with iron
deficiency anemia admitted in tertiary care hospital
- Authors: Mohammed Muzzamil, Mukesh Choudhary, Manoj Nagar, Vishnoi SK, Sandeep Choudhary, Rakesh Jora, Sunil Kothari
  Pages: 167 - 171
  Abstract: Background: Iron deficiency anemia (IDA) can result from both physiological and pathological events, the etiology of underlying IDA should be determined. Helicobacter pylori infection in children has mostly been associated with recurrent abdominal pain, gastric dyspepsia, or duodenal-ulcer. Other extra-digestive tract conditions such as iron deficiency or IDA have been recently related to the H. pylori infection. Aims and Objectives: To find out the prevalence of H. pylori infection in children aged 2–18 years with IDA in a tertiary care hospital. Materials and Methods: Across-sectional observational study was carried out in the Department of Paediatrics, Dr. S.N. Medical College, Jodhpur for a period of 1 year. A total of 52 children aged between 2 and 18 years with anemia (as per the WHO criteria of anemia) were evaluated for complete blood count, peripheral blood film and serum ferritin, serum iron, total iron-binding capacity (TIBC), Upper gastrointestinal endoscopy and two biopsy specimen evaluated for H. pylori and histopathological changes. Normally distributed data means were compared using student’s t-test unpaired and paired. Proportions were compared using Chi-square or Fisher’s exact test. Results: The prevalence of H. pylori in our study population was 32.69%. In children with H. pylori infection mean S.iron was 25.78±10.24 μg/dl, mean S.TIBC 544.66±91.68 μg/dl, and mean S.ferritin was 6.07±3.00 μg/dl. There was statistically significant difference in serum iron, S.TIBC and S.ferritin between children having H. pylori infection and without H. pylori infection(P<0.001). Conclusion: There is an association of IDA and H. pylori infection. Therefore prevention and eradication of H. pylori infection might be helpful to prevent IDA, especially in those patients who are not responding to usual treatment.
  PubDate: 2022-05-03
  DOI: 10.3126/ajms.v13i5.41176
  Issue No: Vol. 13, No. 5 (2022)
Significance of tumor budding in colorectal carcinoma – A tertiary
care center study
- Authors: Preeta Naik, Hemalatha J, Sowmya T S, Nagesha K R
  Pages: 172 - 176
  Abstract: Background: Colorectal carcinoma is one of the leading causes of mortality worldwide. Although the current TNM staging helps in prognostic stratification, these cancers are known to show heterogeneous behavior within the same stage. A search for other prognostic histopathological factors has been in process. One such factor is tumor budding. Aims and Objectives: This study was aimed at enumerating tumor budding, stratifying it, and identifying correlation with other the clinicopathological factors. Materials and Methods: This was a retrospective study conducted in the Department of Pathology, Hassan Institute of Medical Sciences, Hassan. A total of 124 cases were studied. Archived blocks and slides were retrieved, reviewed, and assigned a tumor budding grade on H&E staining. Grade of tumor budding was correlated with various clinical and histopathological parameters for statistically significant association. Results: A total of 124 cases were studied which showed female preponderance (54.8%) in presentation and the most common age group being 61–70years (48%). Adenocarcinoma was the most common histological subtype (83.8%). Lymph node metastasis was observed in 52 cases (42%). The grade of tumor budding was low in 96 cases (77.5%), intermediate in 20 cases (16%), and high in 8 cases (6.5%). Statistically significant association was observed between grade of tumor budding and age, histological grade, lymphovascular invasion, and lymph node involvement. Conclusion: Tumor budding is an independent prognostic marker for adverse prognosis and predictor of lymph node metastasis. Enumerating tumor budding on routine H&E slide is an inexpensive method of providing additional prognostic factors for better patient management.
  PubDate: 2022-05-03
  DOI: 10.3126/ajms.v13i5.43996
  Issue No: Vol. 13, No. 5 (2022)
Comparative study between continuous and interrupted suturing for rectus
sheath closure in exploratory laparotomy
- Authors: Sayak Roy, Kanchan Kundu, Susavan Das, Shib Shankar Kuiri
  Pages: 177 - 182
  Abstract: Background: Exploratory laparotomy is a major surgical procedure. Midline laparotomy is the most common technique of opening the abdomen as it is simple, provides adequate exposure to all four quadrants, and affords quick exposure with minimal blood loss. Laparotomy wounds have been closed in various ways in terms of continuous versus interrupted closure, single layer versus mass closure, and absorbable versus non-absorbable sutures. Aims and Objectives: The aim of the study was to find out the technique of rectus sheath closure in patients undergoing exploratory laparotomy that can reduce the burden of complications in post-operative period. Materials and Methods: It is a hospital-based prospective randomized observational study which was conducted in a rural-based tertiary care hospital and medical college with a time frame of about 1½ years. A total number of 74 patients of adult age group (21–70 yrs) admitted in general surgery ward of Bankura Sammilani Medical College and Hospital, undergoing exploratory laparotomy. Results: Thirty-seven (50%) patients of midline laparotomy were closed in continuous technique. Rest 37 (50%) patients were closed in interrupted technique. The hospital stay was similar in both groups. There was no significant difference in incidence of wound infection (P=0.4687). Wound dehiscence and requirement of burst abdomen repair was significantly higher in continuous suture group as compared to interrupted suture group, but mean closure time (P<0.0001) and mean suture length (P=0.0436) were significantly higher in interrupted suture group. Conclusion: The major complication of emergency laparotomy is wound dehiscence which leads to increased morbidity and subsequent requirement of re-operation of burst abdomen and hospital cost. In our study, we found that interrupted suturing method of abdominal closure is better in respect to major post-operative complications though it requires more suture length and time.
  PubDate: 2022-05-03
  DOI: 10.3126/ajms.v13i5.42155
  Issue No: Vol. 13, No. 5 (2022)
Diagnostic hysterolaparoscopy: An important tool in evaluation of female
infertility, in beneficiaries of ESI scheme in Eastern India
- Authors: Nita Singh, Kaushik Datta Pramanik, Manisha Bajaj, Rajib Roy
  Pages: 183 - 188
  Abstract: Background: The WHO estimates that 60–80 million couples worldwide suffer from infertility and the overall prevalence of the primary infertility in India is 3.9–16.8%. As usual tests and examinations are unable to appreciate majority of pelvic pathology in infertile women, diagnostic laparoscopy has become an essential part of infertility evaluation. Diagnostic laparohysteroscopy (DHL) gives the opportunity to directly visualize and manipulate pelvic organs which allow accurate diagnosis and give an option to treat at the same
  sitting. Aims and Objectives: The aims of this study were to detect pelvic organ abnormalities by diagnostic hysteroscopy and laparoscopy in the evaluation of female infertility in a tertiary care hospital. Materials and Methods: This cross-sectional observational study recruited 50 patients who attended the infertility clinic during 1 year period as per inclusion and exclusion criteria. Those with male factor and endocrine abnormality were excluded from the study. The patients having abnormal hystero-salpingography (HSG) findings and those who in spite of having normal HSG finding, did not conceive even after three cycles of ovulation induction, underwent DHL. Results: Out of the 50 patients, 35 (70%) suffering from the primary and 15 (30%) suffering from the secondary infertility. The mean age of the study population was 29.5±5.3 years. Most of the cases presented with 3–6 years of infertility. The most common reported laparoscopic abnormality was ovarian in 58% cases, followed by 56% of pelvic and peritoneal abnormalities, 44% tubal factor abnormality, 36% having endometriosis at different stages, and 30% having uterine abnormality. Conclusions: Hystero -laparoscopy has good diagnostic accuracy in evaluating pelvic pathologies. The combination of hysteroscopy with laparoscopy done in a single setting improves the detection rate of abnormalities of uterus, fallopian tubes, ovaries, and pelvic peritoneum.
  PubDate: 2022-05-03
  DOI: 10.3126/ajms.v13i5.44227
  Issue No: Vol. 13, No. 5 (2022)
A descriptive study of complications following vaginal surgeries for
genital prolapse
- Authors: Jayavani RL, Kalaranjini S, Arunkumar Muthalu, Latha Chaturvedula, Habeebullah Syed
  Pages: 189 - 195
  Abstract: Background: Pelvic organ prolapse is the descent of the pelvic organs into the vagina accompanied by urinary, bowel, and sexual. Many types of surgeries are done to fix the organ prolapse. Aims and Objectives: This study aims to study the intra-operative and immediate post-operative complications in patients undergoing surgery for genital prolapse. The study also aims to follow the patients for a period of 1 year evaluate the possible morbidity during the period and also assess the factors which contribute to this morbidity. Materials and Methods: The present study was conducted in a tertiary care hospital in Puducherry among 121 patients who were admitted in the department of obstetrics and gynecology for genital prolapse. It was intended to study the intraoperative, early post-operative, and long-term complications among these patients who underwent vaginal surgeries for genital prolapse. Results: Ward Mayo’s operation was done in the age group of 45–50 years and Manchester repair was done in the age group of 30–35 years. Patients who underwent Ward Mayo’s procedure had a parity of 3.5. Nearly 25% of patients had a parity of 25. There was a significant difference in operating time when surgeries were done by consultants when compared to senior residents (P=0.002) but there was no significant difference in blood loss (P=0.070). A significant increase in blood loss and operating time was noted when vaginal hysterectomy was combined with both anterior and posterior repair. In cases of complications, it was prolonged. Backache (4.95%, 4.13%, and 4.13) and psychological problems (4.13%. 6.61%, and 6.61%) after 6 weeks, 6 months, and 1 year, respectively, were common long-term complications that could be attributed to decreased awareness among our women. Conclusion: It is concluded from the study that vaginal surgeries for genital prolapse have lesser complications both intra-operatively and during the post-operative period. The patient’s characteristics such as age, parity, other illnesses, and surgical details such as choice of the operation, experience of the surgeon, additional procedures performed, blood loss, and antibiotic usage influence the morbidities associated with the surgery.
  PubDate: 2022-05-03
  DOI: 10.3126/ajms.v13i5.42779
  Issue No: Vol. 13, No. 5 (2022)
A prospective study on clinical, radiological, and pathological features
in early diagnosis of spinal tuberculosis
- Authors: Praveen Garg, Sushant Bhowmick, Vibhuti Goyal
  Pages: 196 - 200
  Abstract: Background: Spinal tuberculosis (TB) is the most common of musculoskeletal TB. The diagnosis of spinal TB is difficult due to the non-specific symptoms. Clinical assessment, along with radiological features and biopsy, plays an important role in early diagnosis of spinal TB. Aims and Objectives: The aims of this study were to analyze clinical, radiological, and pathological features for early diagnosis of spinal TB and to identify other pathological conditions mimicking spinal TB. Materials and Methods: The present prospective study includes 110 patients. All patients were clinically and radiologically examined. The patients underwent percutaneous biopsy of the involved region and tissue samples were subjected to histopathological examination (HPE) and cartridge-based nucleic acid amplification test (CBNAAT) for definitive diagnosis of spinal TB. Results: Out of 110 cases, male preponderance (65.5%) was seen in comparison to females (34.5%). Dorsal spine (53.7%) and lumbar spine (41.3%) were the most common site of involvement. One hundred patients were confirmed as spinal TB by histopathology and molecular diagnosis. Histopathology alone could make diagnosis in 40 cases while molecular diagnosis in 100 cases and 10 cases were non-tuberculous in etiology (metastatic deposits of carcinoma in five cases, pyogenic spondylodiscitis in three cases and primary neoplastic lesion in two cases, one case of giant cell tumor, and one case of hemangioma each). Conclusion: Spinal TB is a deep-seated and paucibacillary condition difficult to diagnose due to inadequate sample. Therefore, multipronged approach by direct smear examination, HPE, and molecular diagnosis is required for early diagnosis. Culture is the gold standard for diagnosis while CBNAAT is highly sensitive and specific that enables rapid detection of tubercular bacilli and should be considered as first-line test.
  PubDate: 2022-05-03
  DOI: 10.3126/ajms.v13i5.41434
  Issue No: Vol. 13, No. 5 (2022)
The role of nutrients in severe acute respiratory syndrome coronavirus 2
infection
- Authors: Aditi Munmun Sengupta, Diptendu Chatterjee, Rima Ghosh, Khriesivonuo Nakhro, Ipsita Chakravarti, Salil Kumar Bhattacharya
  Pages: 201 - 208
  Abstract: Balanced and healthy nutrition is a vital to attain a good immune response. Numerous studies have reported that boosting up adaptive immunity through nutritional interventions can impede viral infections. With the present leading challenge of the COVID-19 pandemic globally, maintaining good nourishment is indispensable to remain immune against the novel virus. By and large, ineffectively fed people are at a higher risk of creating different kinds of contaminations. In addition, constant and extreme contagion can cause health problems and demolish a patient’s nourishing status, making them susceptible to different diseases. During the COVID-19 pandemic, everyone must screen their eating routine and nourishing status. Good nutrition can subside the ongoing unprecedented health complications and deaths. Evaluating the clinical status of COVID-19 cases at the hour of clinic confirmation is strongly recommended. Specific dietary help is prescribed to be given to those in the high-hazard bunch, asymptomatic transporters, and patients with moderate or extreme COVID infection. An assortment of micronutrients techniques to treat COVID-19 can prove beneficial at the preliminary stage of the clinical attendance. The prompt supplementation of specific supplements in gentle cases can forestall the movement of sicknesses.
  PubDate: 2022-05-03
  DOI: 10.3126/ajms.v13i5.42442
  Issue No: Vol. 13, No. 5 (2022)
Nasal basal cell carcinoma in xeroderma pigmentosum - diagnosis, workup,
management, and reconstruction
- Authors: Sanket D Vakharia, Parag Watve, Gautam Purohit
  Pages: 209 - 212
  Abstract: Xeroderma pigmentosum (XP) is genetic autosomal recessive disorder with photosensitivity on exposure to sun and also presents with various malignancies such as squamous cell carcinoma, basal cell carcinoma, and malignant melanoma. A 22-year-old female visited our outpatient clinic with 18 months history of pigmented nodule on her nose. She was diagnosed with XP since she was 2 years old. Physical examination revealed a waxy, blackish-brown nodule on her nose. Incisional biopsy was performed. The histological findings revealed multiple, palisaded basophilic tumor masses surrounded by prominent infiltrating lymphocytes confirming our clinical diagnosis. She was advised sun protection with the use of protective clothing and glasses. XP leads to chances of various malignancies. Early diagnosis, proper clinical examination, histopathological examination for the diagnosis of condition is must to come to proper diagnosis. Instructions to the patients to take proper protection from sun and wearing protective clothing must be given.
  PubDate: 2022-05-03
  DOI: 10.3126/ajms.v13i5.41345
  Issue No: Vol. 13, No. 5 (2022)
A retrospective analysis of COVID-19 positive patients admitted in a
tertiary care hospital wards in Mizoram, India
- Authors: Sang Zuala, Vankhuma C, Zorinsangi Varte, Ganesh Shanmugasundaram Anusuya, Lalramenga Pachuau
  Pages: 213 - 213
  Abstract: Sir, We would kindly request you to make the corrigendum in the article recently published Original Article in Asian Journal of Medical Sciences with the date of publication on 2022-04-01 in Volume 13 No 4 2022 page number 11-17, with the article titled “A retrospective analysis of COVID-19 positive patients admitted in a tertiary care hospital wards in Mizoram, India” In the website page the order of the authorship is published in a wrong manner, and we realise our mistake for not going through the metadata at the time of submission. We kindly request you to change the order of the authorship as Sang Zuala, Vankhuma C, Zorinsangi Varte, Ganesh Shanmugasundaram Anusuya, Lalramenga Pachuau instead of Ganesh Shanmugasundaram Anusuya, Sang Zuala, Vankhuma C , Zorinsangi Varte, Lalramenga Pachuau Thank you, Dr. Ganesh Shanmugasundaram Anusuya Corresponding Author
  PubDate: 2022-05-03
  DOI: 10.3126/ajms.v13i5.44258
  Issue No: Vol. 13, No. 5 (2022)