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Background and Aims: Epidural steroid injections (ESIs) with or without local anaesthetics have been used for the past several years for the treatment of back pain, especially for radicular symptoms. The aim of this prospective study was to compare the efficacy of midline with parasagittal approach for interlaminar ESI in the management of symptomatic lumbar intervertebral disc herniation. Methods: Sixty patients (aged 20–60 years) with pain pattern consistent with lumbar radiculopathy caused by lumbar intervertebral disc herniation and who did not respond to conservative treatment were included in the study. They were randomly divided in two groups of 30 each: group I (MILESI, n = 30) consisting of midline interlaminar ESI, and group II (PSILESI, n = 30) consisting of parasagittal interlaminar ESI. They were administered a combination of 80 mg of methylprednisolone acetate (40 mg/ml) and 6 ml of 0.25% bupivacaine (total volume of 8 ml). Pain, patient satisfaction, and the Oswestry Disability Index (ODI) were assessed at different time intervals before and after the procedure for up to six months. Results: The improvement in pain score after ESI was statistically significant in both the groups at all intervals of time, with no significant difference between the two groups. The mean pain score was <3 from two weeks onwards after the injection. The pain score decreased by more than five points and it was around two points at the end of the six-month study period. Around 50% of patients in both groups had excellent satisfaction. Conclusion: Both techniques were effective in providing good analgesia. Pain relief and improvement in disability were clinically better with the parasagittal interlaminar approach. [ABSTRACT FROM AUTHOR]

Aims and Objective: The aims and objective of this study to share the 15 years of working experience regarding importance of cartridges and resins used in a Purification Column during 18F-FDG synthesis. Materials and Methods: 18F-flourodeoxyglucose (18F-FDG) is common radiotracer used in positron emission tomography (PET). 18F-FDG is synthesized in a PET radiochemistry synthesis module and purification column is an integral part of 18F-FDG synthesis. The purification column has four integral parts, namely of ion exchange retardation resin, cation exchange resin, C18 bonded silica, Neutral Alumina. Conclusion: The purification column plays a very important role during the synthesis of 18F-FDG. If all parts of the purification column are intact, then maximum transfer of produced 18F-FDG from reaction vessels to the final product vial takes place. The total yield of 18F-FDG is also dependent upon the purification column. If all components of purification column placed tightly and properly charged then there is a high possibility of maximum yield of final product without impurities. [ABSTRACT FROM AUTHOR]

Achondroplasia is an autosomal dominant inherited disorder that results in premature ossification of the epiphyseal growth plates and restriction of proximal long bone movement. Herein, we report the anesthetic management of such a patient undergoing stone retrieval in the lithotomy position. He had a restricted ability to flex and abduct the hip joint and lumbar hyperlordosis. These were anticipated to be a concern for the lithotomy position and prone to positional injuries. Hence, the decision was made to position the patient before induction of anesthesia in the presence of surgeons to ensure the optimal exposure needed for the procedure while avoiding any hyperflexion or abduction of the hip and knee joints. The position tolerated by the patient when awake and unsedated should be followed intraoperatively. Achondroplasia is also associated with difficult airway features, obesity, sleep apnea, and multisystem involvement. Careful preoperative evaluation and intraoperative vigilance are needed to manage these patients undergoing surgery. [ABSTRACT FROM AUTHOR]

Rhino-orbitol-cerebral mucormycosis (ROCM) is seen as a common post-coronavirus disease (COVID-19) fungal infection in India. It is a lethal, opportunistic infection of the paranasal sinuses and brain caused by fungi of the Mucorales, most commonly with Rhizopus spp. Early diagnosis and timely management are essential. Other studies have shown high mortality up to 25–60%. However, in this study, the recovery rate is very high. We aimed to present six post-COVID mucor cases and to review the literature in terms of prevention, diagnosis, and management of this fatal infection. We carried out a retrospective case series of six patients with a confirmed diagnosis of ROCM presenting to a single tertiary-level hospital during the second wave of covid 19 pandemic. Clinical details for each case was obtained from the hospital information system. A total of six patients (five males and one female) were diagnosed with ROCM during this period. Out of six patients, four had diabetes mellitus and all were on steroid treatment during COVID-19 infection. The most common presenting features were headache (100%), facial pain (80%), orbital swelling (80%), and earache (20%). Most of the patients had sinusitis as a predominant finding in preop magnetic resonance imaging (MRI) at presentation. All patients received liposomal amphotericin B (LAmB) as the first line of treatment and subsequently shifted to posaconazole. The overall recovery rate was 100% and patients were discharged. ROCM infection is very hard to treat. The studies have shown cases with late presentation spreading beyond paranasal sinuses. Early intervention and treatment with antifungals and extensive surgical debridement resulted in the full recovery of all six cases. [ABSTRACT FROM AUTHOR]

Background: In children with anorectal malformations (ARM), the vertical fibres of the striated muscle complex (SMC) are believed to be located within the limits of the anal dimple (AD). Methods: Forty five cases of ARM underwent posterior sagittal anorectoplasty (PSARP), median age 8.5 months. During PSARP the anterior, posterior limits and midpoint of the AD and SMC were marked. The location of AD was correlated with SMC. Results: A 'well developed' AD and SMC was seen in 80 % and 86.7 % patients respectively. The mean width of the AD and SMC was more in females than in males (20.96 vs. 18.98 mm and 14.24mm vs. 13.45mm respectively). In 36 cases (80 %), across the spectrum of ARM, the SMC was posterior in relation to the AD. In 7 cases (15.5 %) it correlated in position with the AD and in 2 cases (4.44 %), it was anterior to the AD. Conclusions: In the majority of cases AD and SMC were 'well developed' and the location of the SMC does not correlate with that of the AD. This has significant practical value in the important step of optimizing the placement of the rectum through the center of the SMC during repair. [ABSTRACT FROM AUTHOR]

Aim: The aim of the study was o define the preoperative diagnostic clinical and radiological features in girls with congenital pouch colon (CPC). Materials and Methods: Records of 47 girls with CPC, managed from 1996 to 2018, were reviewed. There were two age groups: Group A (newborn to 12 months; n = 26) and Group B (>12 months to 20 years; n = 21). The important clinical and radiologic features to help in a preoperative diagnosis were noted. Results: The most common subtype was Type II (57.4%), followed by Type I (23.4%) and Type III (12.8%). The features common to both the groups were abdominal distension (A = 53.8%; B = 9.52%), severe perineal excoriation (A = 19.2%; B = 23/8%), and urinary incontinence (A = 30.7%; B = 85.7%). In addition, in Group B, fecaloma on abdominal palpation was noted in 28.6% of patients. The characteristic appearance of the perineum including external genitalia and findings on plain abdominal X-ray (AXR) were 100% accurate and hence diagnostic. These unique features helped us formulate an algorithm for preoperative diagnosis of this uncommon form of anorectal malformation in girls seen in North India. Conclusions: The characteristic features on clinical examination should alert one to the presence of CPC in the outpatient clinic. The AXR was diagnostic in 100% of cases and is mandatory. If any doubt persists, examination of the genitalia under anesthesia with more retraction of the labial folds and endoscopy can be performed for confirmation. These measures should enable a clinician to make an accurate preoperative diagnosis in every girl with CPC. [ABSTRACT FROM AUTHOR]

We report a case of colonic agenesis with anorectal malformation in a newborn girl. The patient also presented with congenital heart disease. We are presenting the clinical features, intraoperative findings, and treatment plan. [ABSTRACT FROM AUTHOR]

Background: Malocclusions are expected to affect subjective attraction, social recognition, and intellect. For dentofacial deformities, functional concerns can also arise. The previous research has established a gradient on oral health-related quality of life (OHRQoL) scores through malocclusion intensity, particularly in the social and emotional realms. This study is used to assess the quality of oral health. Materials and Methods: A total of sixty patients began orthodontic therapy at a tertiary-care facility. Treatment in the orthodontic clinic is restricted to serious malocclusions. The study was selected from patients who meet the qualifying requirements of extreme malocclusion and orofacial clefting. The research removed patients with diagnosed hereditary syndromes. Patients got either single-arch or double-arch fixed equipment during their orthodontic procedure. Subjects were categorized as orthodontic patients with extreme malocclusions, needing orthodontic therapy, and severe spinal discrepancies, requiring both orthodontic treatment and orthognatic surgery. The overall score of one subject was 0–56, while the domain score was 0–8. Higher ratings for oral health profiles reflect a stronger effect on the relative quality of life of oral health. Results: For the 14 objects, the mean baseline Oral Health Impact Profile-14 (OHIP-14) score for all three categories was not statistically different for about half of the items. For surgery participants, the OHIP-14 baseline scores were nearly twice as large as the scores of the other two categories for each of these things (P = 0.05). There were a lot of statistically important variations involving the categories, and the three most significant ones are revealing pattern here. The multiple comparison power of nonsignificant predictive variables was extremely weak for the area of physical pain is 5.2%; 41.2% of remaining tests, and 84% for the functional limitation and mental deficiency domain. Conclusion: Patients receiving a mixture of orthognathic surgery and orthodontic therapy have comparatively low OHRQoL baseline; however in contrast with normal and cleft patients, they still gain the most from care. [ABSTRACT FROM AUTHOR]

Background: The incidence of dental caries and gingival disease is at higher level in orthodontic patients. The present study demonstrated oral health status of patients undergoing fixed orthodontics. Methodology: A total of 168 patients age ranged 12–17 years who were undergoing orthodontic treatment for 2 years of both genders were recruited. The assessment of dental caries as Decayed, Missing, and Filled Teeth (DMFT) score and plaque index was determined at first, second, and last visits. Results: Age 12 years had 22 males and 28 females, 13 years had 14 males and 22 females, 14 years had 8 males and 18 females, 15 years had 7 males and 15 females, 16 years had 6 males and 14 females, and 17 years had 9 males and 5 females. The mean DMFT score in age group 12 years was 1.74 and 2.24 at first and third visits, respectively, at 13 years was 1.60 and 2.04 at first and third visits, respectively, at 14 years was 2.38 and 2.72 at first and third visits, respectively, at 15 years was 1.74 and 2.08, at 16 years was 3.32 and 3.56 and at 17 years was 3.40, and 3.64 at first and third visits, respectively. Conclusion: There was significant higher dental caries and plaque index in age group 12 years. [ABSTRACT FROM AUTHOR]

Pelvic magnetic resonance imaging (MRI) is the latest addition to already existing tools for evaluation of anorectal malformation (ARM). It provides detailed information about pelvic floor musculature as well as position of rectal pouch. However, lack of knowledge about normal pelvic floor anatomy can lead to misinterpretation of pelvic MRI which can create confusion and change in approach for surgery. A 14-month-old male child with diagnosis of ARM was evaluated with pelvic MRI. There was finding of abnormal protrusion of fat through the ischiorectal fossa which was misinterpreted as Currarino syndrome which created confusion immediately before posterior sagittal anorectoplasty. Pelvic MRI is highly informative while evaluating a case of ARM. However, a detailed knowledge of pelvic floor anatomy is mandatory to avoid wrong interpretation and misdiagnosis. [ABSTRACT FROM AUTHOR]

Background: Malocclusions are expected to affect subjective attraction, social recognition, and intellect. For dentofacial deformities, functional concerns can also arise. The previous research has established a gradient on oral health-related quality of life (OHRQoL) scores through malocclusion intensity, particularly in the social and emotional realms. This study is used to assess the quality of oral health. Materials and Methods: A total of sixty patients began orthodontic therapy at a tertiary-care facility. Treatment in the orthodontic clinic is restricted to serious malocclusions. The study was selected from patients who meet the qualifying requirements of extreme malocclusion and orofacial clefting. The research removed patients with diagnosed hereditary syndromes. Patients got either single-arch or double-arch fixed equipment during their orthodontic procedure. Subjects were categorized as orthodontic patients with extreme malocclusions, needing orthodontic therapy, and severe spinal discrepancies, requiring both orthodontic treatment and orthognatic surgery. The overall score of one subject was 0-56, while the domain score was 0-8. Higher ratings for oral health profiles reflect a stronger effect on the relative quality of life of oral health. Results: For the 14 objects, the mean baseline Oral Health Impact Profile-14 (OHIP-14) score for all three categories was not statistically different for about half of the items. For surgery participants, the OHIP-14 baseline scores were nearly twice as large as the scores of the other two categories for each of these things (P = 0.05). There were a lot of statistically important variations involving the categories, and the three most significant ones are revealing pattern here. The multiple comparison power of nonsignificant predictive variables was extremely weak for the area of physical pain is 5.2%; 41.2% of remaining tests, and 84% for the functional limitation and mental deficiency domain. Conclusion: Patients receiving a mixture of orthognathic surgery and orthodontic therapy have comparatively low OHRQoL baseline; however in contrast with normal and cleft patients, they still gain the most from care. [ABSTRACT FROM AUTHOR]

Background: The incidence of dental caries and gingival disease is at higher level in orthodontic patients. The present study demonstrated oral health status of patients undergoing fixed orthodontics. Methodology: A total of 168 patients age ranged 12-17 years who were undergoing orthodontic treatment for 2 years of both genders were recruited. The assessment of dental caries as Decayed, Missing, and Filled Teeth (DMFT) score and plaque index was determined at first, second, and last visits. Results: Age 12 years had 22 males and 28 females, 13 years had 14 males and 22 females, 14 years had 8 males and 18 females, 15 years had 7 males and 15 females, 16 years had 6 males and 14 females, and 17 years had 9 males and 5 females. The mean DMFT score in age group 12 years was 1.74 and 2.24 at first and third visits, respectively, at 13 years was 1.60 and 2.04 at first and third visits, respectively, at 14 years was 2.38 and 2.72 at first and third visits, respectively, at 15 years was 1.74 and 2.08, at 16 years was 3.32 and 3.56 and at 17 years was 3.40, and 3.64 at first and third visits, respectively. Conclusion: There was significant higher dental caries and plaque index in age group 12 years. [ABSTRACT FROM AUTHOR]

Chronic myeloid leukemia (CML), BCR-ABL1-positive, is classified as a myeloproliferative neoplasm predominantly composed of proliferating granulocytes and determined to have the Philadelphia chromosome/translocation t (9;22)(q34;q11.2). Skin is said to be the mirror to systemic diseases, with skin manifestations ranging from nonspecific cutaneous lesions to specific lesions. The cutaneous manifestations of CML are generally reddish-brown to violaceous papules and nodules, indurated or hemorrhagic plaques, perifollicular acneiform papules, bullae, and palpable purpura. Other unusual manifestations could be erythema nodosum, pyoderma gangrenosum, erythema annulare centrifugum, and so on. Here we present a case of a 50-year-old woman with a history of recurrent pruritic skin lesions and erythema annulare centrifugum as the presenting complaint of CML. [ABSTRACT FROM AUTHOR]

Scrub typhus is caused by Orientia tsutsugamushi (formerly Rickettsia) and is transmitted to humans by an arthropod vector of the Trombiculidae family. Recent reports suggest that there has been resurgence of rickettsial infections in the Indian subcontinent. As the clinical features of scrub typhus are nonspecific and closely mimic that of other tropical infections, its diagnosis is often delayed or missed. It may cause serious complications such as myocarditis, meningoencephalitis, acute renal failure, acute liver failure, pneumonia, acute respiratory distress syndrome (ARDS), disseminated intravascular coagulation, and multiorgan dysfunction syndrome. Early diagnosis is important because the response to treatment is excellent and may help prevent complications. Here, we report a case of scrub typhus in a pregnant woman complicated by ARDS; however, timely diagnosis and institution of therapy helped save two precious lives. [ABSTRACT FROM AUTHOR]

Background: Conventional glass ionomer cement (CGIC) has many beneficial properties, but it has poor physical and mechanical properties. Therefore, new glass ionomer cement (GIC) is manufactured by adding zinc to improve the mechanical properties of GIC ChemFil Rock. This material possesses better flexural tensile strength and compressive strength in comparison to conventional to CGIC. Objectives: The aim of this study was to compare four properties of ZRGI like fracture toughness, surface micro-hardness, abrasive wear, and roughness to other GIC material, which are commercially available as: resin-coated glass ionomer (EQUIA FIL). Materials and Methods: The study was done in dual phase. In phase-1, micro-hardness surface roughness, abrasion of four GIC and a composite resin as control was analyzed and in phase-2, fracture toughness of four GIC was done at 24 h interval so that all cement achieve its peak strength. Results: Micro-hardness value of ChemFil Rock was lowest among different GIC groups. All four GIC group exhibit similar abrasion capacities, while composite were more wear-resistant significantly. Roughness change was highest on ChemFil Rock compared to other GIC. EQUIA FIL has the highest fracture toughness, followed by ChemFil Rock. Conclusion: We can conclude that incorporating zinc in the matrix of chemfil rock increases fracture toughness and good abrasive wear, but it does not improve micro-hardness or surface roughness. [ABSTRACT FROM AUTHOR]

Background: Conventional glass ionomer cement (CGIC) has many beneficial properties, but it has poor physical and mechanical properties. Therefore, new glass ionomer cement (GIC) is manufactured by adding zinc to improve the mechanical properties of GIC ChemFil Rock. This material possesses better flexural tensile strength and compressive strength in comparison to conventional to CGIC. Objectives: The aim of this study was to compare four properties of ZRGI like fracture toughness, surface micro-hardness, abrasive wear, and roughness to other GIC material, which are commercially available as: resin-coated glass ionomer (EQUIA FIL). Materials and Methods: The study was done in dual phase. In phase-1, micro-hardness surface roughness, abrasion of four GIC and a composite resin as control was analyzed and in phase-2, fracture toughness of four GIC was done at 24 h interval so that all cement achieve its peak strength. Results: Micro-hardness value of ChemFil Rock was lowest among different GIC groups. All four GIC group exhibit similar abrasion capacities, while composite were more wear-resistant significantly. Roughness change was highest on ChemFil Rock compared to other GIC. EQUIA FIL has the highest fracture toughness, followed by ChemFil Rock. Conclusion: We can conclude that incorporating zinc in the matrix of chemfil rock increases fracture toughness and good abrasive wear, but it does not improve micro-hardness or surface roughness. [ABSTRACT FROM AUTHOR]

Background and Objective: Stem cell therapy has emerged as a potential therapy for the treatment of stroke. We performed a systematic review and meta-analysis of published randomized controlled studies using various types of stem cell therapies in patients with ischemic stroke (IS). Method: Literature search was carried out using PubMed, Google Scholar, Cochrane library, and clinicaltrial.gov to identify studies on stem cell therapy in IS from its inception till January 2020. Data were extracted independently by two reviewers. STATA version 13 was used for carrying out meta- analysis. We included only randomized controlled trials (RCTs) if any of the stem cell therapy was used to treat patients with IS in any phase after the index stroke. Results: We included a total of eight randomized controlled studies involving 459 subjects (217 intervention and 242 controls) in the meta-analysis. We did not observe statistically significant reduction in mean NIHSS score in the intervention group (SMD - 0.34, 95% CI - 0.76 to 0.08) in patients with acute or sub-acute stroke. However, a statistically significant reduction (SMD - 1.57, 95% CI -2.22 to -0.92) was observed in patients with chronic ischemic stroke. Statistically non-significant reduction in mean mRS in the intervention group (SMD 0.04, 95% CI -0.20 to 0.28) in patients with acute or sub-acute ischemic stroke was observed, however a statistically significant reduction (SMD - 1.07, 95% CI - 1.94 to -0.19) was noted in patients with chronic stroke. We did not observe statistically significant reduction in mean Barthel index score (SMD 0.24, 95%CI -1.69 to 2.17) in chronic stroke. Statistically non-significant lower mortality rate was observed in intervention group compared to controls (Risk Ratio 0.84, 95% CI 0.43 to 1.66) among acute or sub-acute, as well as in the chronic stroke group (Risk Ratio 0.47, 95% CI 0.20 to 1.09). Conclusion: Our meta-analysis provides no clinically important evidence for efficacy of stem cells in reducing neurological deficit compared to control group. Well-designed large randomized controlled trials are required to provide more information on the efficacy of stem cell therapy in patients with IS. [ABSTRACT FROM AUTHOR]

Background: Burnout syndrome has been widely reported in nursing staff. It is more pronounced in intensive care setting (up to 80%). This survey was designed to assess the prevalence of burnout and its correlates among critical care nurses. Methods: Anonymous questionnaire was distributed to all ICU nursing staff of a tertiary care teaching hospital. Questionnaire had 25 questions covering – demography, job characteristics, Visual Analogue Scale for stress, co-worker support, work–life balance, question for measuring burnout, job satisfaction, turnover intention, organizational commitment, for depression screening and psychosomatic symptoms. The burnout scale score was used to dichotomize into low burnout (<3) or high burnout (> = 3) group. These two groups were compared using Chi-square test, Fischer's exact test for categorical variables and independent t-test for continuous variables. Significant variables were entered in multivariate logistic regression analysis. Results: Out of 150 ICU nurses, 125 (83.3%) gave completely filled questionnaires which were evaluated. 47 (37.6%) participants reported experiencing high burnout. Binary logistic regression model revealed that lack of specialized ICU training (OR = 4.28, 95% CI: 1.62 to 11.34, P = 0.003), performing extra duty in last month (OR = 5.28, 95% CI: 1.90 to 14.67, P = 0.001), High physical symptoms in last 12 months (OR = 4.73, 95% CI: 1.56 to 14.36, P = 0.006) and mid-level experience (1–5 years) were significantly associated with burnout. Conclusions: Burnout is significantly prevalent (37.6%) among intensive care nurses. Specialized training and limiting work hours can help in mitigating this problem. High frequency of physical symptoms could be early indicators of burnout. [ABSTRACT FROM AUTHOR]

The de Winter's pattern is an electrocardiography (ECG) finding characterized by ST depression and tall prominent T-waves in precordial leads with ST elevation in lead aVR. It signifies the occlusion of proximal left anterior descending artery (LAD). Although it is considered a ST-elevation myocardial infarction (STEMI) equivalent, current guidelines recommend against the use of thrombolytic therapy in the absence of STEMI. As the question whether to use thrombolysis in such situations remains unanswered and controversial, we preferred to provide thrombolytic therapy with tenecteplase to our patient admitted with acute retrosternal chest pain with de Winter's ECG pattern so as to prevent myocardial damage and improve the patient outcome as the percutaneous coronary intervention facility was not immediately available. The thrombolysis was successful and the proximal LAD occlusion was confirmed later on coronary angiography which was treated with stent implantation. This case report tends to highlight the therapeutic dilemma while managing patients with de Winter's ECG pattern. [ABSTRACT FROM AUTHOR]

Background and Aims: To assess and compare the effect of bilateral continuous rectus sheath infusion (CRSB) for postoperative analgesia with continuous thoracic epidural infusion (TEA) in patients undergoing midline incision laparotomies. Methods: A prospective, randomised study involving sixty patients with Indian Society of Anesthesiologists (ASA) grade I to III, planned for elective laparotomy were enrolled for the study. Patients were randomly allocated into two groups. In the TEA group, an epidural was sited before induction of general anaesthesia (GA), whereas in the CRSB group, bilateral ultrasound-guided RSB catheters were placed at the end of the surgical procedure, before extubation. Both groups received continuous 0.2% Ropivacaine infusion for postoperative analgesia. They were followed for two post-operative days (POD), for the opioid requirement and post-operative pain at rest, coughing, and moving. Age and body mass index (BMI) were compared using independent t-test and visual analogue scale (VAS) scores were compared by the Mann–Whitney test between the two groups. Opioid consumption, gender, and type of surgery were compared using the Chi-Square test. Statistical analysis was done using Statistical Package for Social Sciences (SPSS 21.0). Results: Opioid consumption in both groups was comparable, for the first two post-operative days with no statistically significant difference. Pain scores were comparable among the groups at all times except postoperative day (POD) 0 (4 h and 12 h postop) and POD 2 (8 AM and 12 PM), where lower pain scores were observed in CRSB Group. Conclusions: As a part of the multimodal analgesia technique, CRSB offers a reliable, safe, and effective alternative to TEA. [ABSTRACT FROM AUTHOR]

Aim: To examine the significance of cigarette prices, statuary warning, anti-tobacco camp or advertisement in influencing smoking cessation and the motivation to quit tobacco use.Tobacco use is highly prevalent all over the world. Tobacco smoking and chewing affects almost all the systems of the body. Subjects: Tobacco (smokeless and smoking) male participants aged between 18 and 50 years were recruited. Materials and Methods: Participants were asked to complete a questionnaire related to smoking habits, the Fagerstrom test for nicotine dependence questionnaire, and effect of price hike, statuary warning, anti-tobacco camp or advertisement. Results: Tobacco user with moderate and high dependent showed no effect in use of tobacco of price hike, statuary warning, anti-tobacco camp or advertisement. Conclusion: This study provides a unique opportunity to study tobacco cessation among tobacco user and their response to tobacco prices, statuary warning, anti-tobacco camp or advertisement. Higher tobacco prices appear to be associated with greater motivation to stop tobacco habit. [ABSTRACT FROM AUTHOR]

Context: Directly observed treatment short course (DOTS) was adopted as the strategy for the provision of treatment to increase treatment completion. Poor adherence to medication has been noted and poses a big challenge even after achieving 70% case detection and 85% cure rate. The focus remains on dealing with important reasons of default and timely retrieval of patients who interrupt the treatment. Aims: The aim of the study was to measure the noncompliance of DOTS and to determine the reason for the same among patients in rural area of Pune. Materials and Methods: An observational cross-sectional study was conducted with a study population comprising the patients who were getting treatment in November 2016 and must have completed at least 1 month of treatment in Mulshi block. The study period was from November 2016 to January 2017. All the patients were interviewed using a pretested questionnaire for their compliance. Results: The total number of patients included in the study was 88. The age was 18-70 years in which 77.3% were male and 22.7% were female. We found 71.6% new cases, and 27.3% were the previously treated patients, whereas 1.1% were multidrug-resistant patients. Among these patients, 25% were tobacco chewers and 31.8% were smokers. We found that 61.4% were compliance patients and 38.6% were noncompliance patients. Reasons given by the patients were side effects, stigma of the society, migration from one place to another, and felt better from symptoms after taking medication. Conclusion: Noncompliance in our study is high. We should take steps regarding this so that people adhere to the medication. [ABSTRACT FROM AUTHOR]

Introduction: Manuka honey has been used in chronic diabetic ulcers and traumatic wounds. We have used Manuka honey in cases of otitis externa because of its antibacterial and anti-inflammatory properties. Objectives: The objective was to study the efficacy of topical applications of Manuka honey in the patients of acute otitis externa. Materials and Methods: Patients with acute otitis externa without any prior ear complaint or intervention were selected for the study after informed and written consent. All patients selected for the study were packed with Manuka honey-impregnated umbilical tape and pain scores; canal wall edema was recorded on days 0, 1, 3, and 7. Results: A total of 20 patients were included in our study. Twenty patients followed us on day 1, 15 patients on day 3, and seven patients followed us till day 7. The mean pain score for day 0 was 5.35, and the mean pain score decreased to 2.95 on day 1, and the difference was statistically significant. Conclusion: Manuka honey appears to be an effective therapeutic agent in the management of otitis externa. [ABSTRACT FROM AUTHOR]

COVID-19 pandemic has been caused by severe acute respiratory syndrome coronavirus 2 which has caused worldwide health concerns. A 48-year-old female suffering from COVID-19 was started on favipiravir (FPV) along with other drugs. Within 12 h of initiation of FPV, the patient developed urticaria all over the body. She was given stat dose of injection dexamethasone and injection avil. Symptoms resolved within 3 days. Urticaria is a rare side effect of FPV but requires vigilant monitoring in the treatment of COVID-19 patients. [ABSTRACT FROM AUTHOR]

Background and Aims: Ultrasound-guided (USG) transversus abdominis plane (TAP) block has emerged as a safe and effective regional anesthesia technique as it provides adequate postoperative pain relief for lower abdominal surgeries. Caudal block is a gold standard technique in pediatric surgeries. Our aim was to compare the duration of postoperative analgesia between TAP block and caudal block in children undergoing inguinal hernia surgeries. Material and Methods: In a prospective, randomized, controlled study, 112 children of age 2-8 years and ASA grade I and II, undergoing elective inguinal hernia surgery were randomly allocated into two groups: Group T (n = 56) received USG-guided TAP block with 0.5mL/kg of 0.2% ropivacaine and Group C (n = 56) received caudal block with 1mL/kg of 0.2% ropivacaine. The primary outcome variable was the duration of postoperative analgesia and the secondary outcome variables included variation in hemodynamic parameters and adverse effects, if any. Results: There was no significant difference in median of CHEOPS score till 5 postoperative hours, thereafter till 24 postoperative hours, significantly lower CHEOPS score were found in Group T. Mean duration of analgesia was 523.44 ± 61.30 min in Group T, whereas in Group C, it was 352.59 ± 32.54 min. No significant difference was observed in hemodynamic variations and adverse effects. Conclusion: TAP block and caudal block both are effective in providing postoperative analgesia in children undergoing inguinal herniotomy. USG-guided TAP block was found to be superior as it provided longer duration of analgesia and reduced rescue analgesic dose without any significant adverse effects as compared with caudal block after inguinal herniotomy. [ABSTRACT FROM AUTHOR]

Context: Preoperative anxiety in surgical patients imposes stress and dissatisfaction. It results in altered neuroendocrine response and various perioperative complications. Aims: This study was conducted to determine the changes in anxiety level and need for information about the anesthetic and the surgical procedures at three different time points before surgery and evaluate the correlating factors. Settings and Design: A prospective observational study in a university hospital. Materials and Methods: Five hundred adults, American Society of Anesthesiologists Physical Status Class 1 and 2 patients were included in this study. Level of anxiety and need for information were assessed with the Amsterdam Preoperative Anxiety and Information Scale at three time points before the surgery: Evening before surgery in the ward (T1); on the day of surgery, in the preoperative holding area (T2); and in the operating room, after being positioned on the operating table (T3). T-test was applied to compare the mean between two groups, and the Chi-square test for independence of association between two categorical variables. Mann–Whitney–Wilcoxon test was applied to test the equality of distribution between two groups. Kruskal–Wallis test was applied for one-way analysis for comparing median score, and Friedman test was applied for two-way analysis of comparing score among three time points. Results: Total anxiety score recorded was significantly different over the time period (P = 0.023), with an increasing trend over the time. Need for information did not change significantly over time period. Conclusions: Preoperative anxiety continues to increase from ward to operation table. The factors responsible are nonmodifiable. [ABSTRACT FROM AUTHOR]

Context: At present, various questionnaires are being used to assess the effect of hearing loss on quality of life. Majority of questionnaires assessing hearing handicap in adults are in English language, whereas Indian population is predominantly Hindi speaking. Hence, the study is aimed at developing a questionnaire in Hindi language, assessing the impact of unilateral sensorineural hearing loss (USNHL) on quality of life. Aim: The aim of the study is to translate Hearing Handicap Inventory for Adults (HHIA) into Hindi language and to validate it for evaluating the impact of USNHL on quality of life. Settings and Design: This is a cross-sectional study of 15 patients at ENT outpatient department of a tertiary care center. Materials and Methods: A previously validated questionnaire - HHIA - was translated into Hindi. Fifteen patients of USNHL were evaluated using this translated questionnaire - HHIA-Hindi (HHIA-H). The responses were analyzed, and Cronbach's alpha was calculated to measure the internal consistency of the questionnaire. Results: The Cronbach's alpha score for HHIA-H was found to be 0.895 (0.829 for emotional subscale and 0.848 for social subscale), which is significant, and hence it shows good internal consistency. Conclusion: HHIA-H showed good internal consistency, and it can be recommended to be used for assessing the impact of USNHL on the quality of life. [ABSTRACT FROM AUTHOR]

Scrub typhus, a mite-borne zoonotic disease, is endemic in several parts of India. It may cause multisystemic disease involving lungs, heart, spleen, liver, hematological system, and nervous system. Neurological involvement may include meningoencephalitis, cerebellitis, cranial nerve palsies, plexopathy, transverse myelitis, muscle dysfunction, neuroleptic malignant syndrome, parkinsonian syndrome, and Guillain–Barre syndrome. Here, we report a rare patient of scrub typhus, who developed meningoencephalitis followed by long-segment myelitis and axonal polyneuropathy, with hepatic, renal, hematological, and pulmonary involvement, following acute febrile illness with associated neurocysticercosis. He gained consciousness with a resolution of almost all of his complaints, with the exception of muscular power, which showed partial improvement following treatment with doxycycline, azithromycin, and steroids. What needs to be explored is whether the existence of neurological scrub typhus with neurocysticercosis is the coincidental price paid for living in the tropics or there is something more to it as in case of Japanese encephalitis and neurocysticercosis co-infection. [ABSTRACT FROM AUTHOR]

Background: India records 5 lakh child‑deaths annually due to vaccine preventable diseases. As a strategic endeavor, the Ministry of Health and Family Welfare, Government of India, launched Mission Indradhanush in December 2014 to achieve more than 90% full immunization coverage by the year 2020. Objectives: To assess the awareness of the respondents about Mission Indradhanush, to assess their attitude and practices regarding childhood immunization, and to determine the association between knowledge and practice with selected variables. Materials and Methods: A cross‑sectional study was undertaken from June to September 2017 among mothers with children aged 12–23 months in urban slums under field practice area of Community Medicine Department, Kalinga Institute of Medical Sciences, Bhubaneswar. Results: Mean age of the children was 17.23 ± 3.43 months; 65% were males and 35% females. Mean age of the respondents was 24.48 ± 3.97 years; 68% were literate and 94% were Hindus. Majority (76%) belonged to upper‑lower Kuppuswamy socio‑economic status scale. Only 10% had heard about Mission Indradhanush; health worker (90%) being the most common source of information. A total of 91% believed that vaccination prevented disease. A total of 96% believed that immunization was important for their children. A total of 73% had the maternal and child protection card with them. A total of 72% of children were fully immunized. Of the 28% partially vaccinated children, only 12.5% had heard about Mission Indradhanush. Reasons stated for partial immunization were mother too busy, child illness, and lack of information. Conclusion: Very few participants had heard about Mission Indradhanush in this study although most of them were aware of immunization services. Strengthening of Information, Education, Communication (IEC) activities regarding the program—Mission Indradhanush—needs attention. The immunization coverage was satisfactory. [ABSTRACT FROM AUTHOR]

Background and Aims: Patients undergoing ovarian cancer surgery after chemotherapy and requiring opioid-based patient-controlled analgesia (PCA) are at high-risk of postoperative nausea and vomiting (PONV). We aimed to assess the effect of palonosetron and dexamethasone combination for these patients for prevention of PONV. Methods: This study included 2 groups and 150 patients. At the time of wound closure, patients in group A received ondansetron 8 mg intravenous (IV) + dexamethasone 4 mg IV and group B received palonosetron 0.075 mg IV + dexamethasone 4 mg IV. Postoperatively for 48 hours, group A patients received ondansetron 4 mg 8 hourly IV, group B patients received normal saline 8 hourly IV in 2 cc syringe. The primary objective was the overall incidence of PONV. Independent t-test, Chi-square test, and Fisher's exact test were used and multivariate regression analysis was done. Results: Vomiting was significantly higher in group A (37.3%) as compared with group B (21.3%) at 0-48 hours (P = 0.031). Significantly more patients in Group A had nausea as compared with group B at 90-120 minutes (30.66% vs 18.66%, P = 0.043) and 6-24 hours (32.0% vs 22.66%, P = 0.029). PCA opioid usage in microgram was significantly higher in group A at 0-24 hours (690.53 ± 332.57 vs 576.85 ± 250.79, P = 0.024) and 0-48 hours (1126.10 ± 512.18 vs 952.13 ± 353.85, P = 0.030). Conclusion: Palonosetron with dexamethasone is more effective than ondasetron with dexamethasone for prevention of PONV in post-chemotherapy ovarian cancer surgeries receiving opioid-based patient controlled analgesia. [ABSTRACT FROM AUTHOR]

Objectives: The objective of the study is to compare the fracture resistance of endodontic treated tooth restored with GIC, amalgam, and composite cements. Materials and Methods: Forty teeth were divided into 4 groups of 10 teeth each. Group I teeth were restored with silver amalgam. Group II teeth were restored with GIC. Group III teeth were restored with composite and Group IV teeth were control in which no alteration was performed. Testing machine applied force on teeth to detect fracture resistance. Results: The mean fracture resistance was maximum in Group IV (1050.2 N) followed by Group III (956.2 N), Group I (836.4 N), and Group II (766.4 N). The difference was statistically significant (P < 0.05). The mean difference of fracture resistance was significant (P > 0.05). Conclusion: Composite resin possesses highest fractures resistance as compared to GIC and silver amalgam. [ABSTRACT FROM AUTHOR]

Embryology of stapes has long been a topic of controversy. There are theories stating a single source to the dual origin of stapes. Chronic otitis media is also known to cause various acquired bony ossicular fixations. We present a case of an 11-year-old female with right chronic otitis media, active squamosal with cerebellar abscess who underwent drainage of cerebellar abscess followed by tympanomastoidectomy as a two-staged procedure. Intraoperatively, there were stapes suprastructure fusion to the fallopian canal and one crural attachment to the promontory. There are no clear criteria to differentiate bony fixation of congenital origin from acquired causes. This case also highlights the need to add a new subclass in the classification of minor middle ear anomalies given by Cremer, and our findings also support the dual origin for stapes development. [ABSTRACT FROM AUTHOR]

Background: Factor V Leiden is the most common genetic variation among the blood coagulation pathway which leads to prothrombotic state, therefore, is considered an important gene for understating the stroke mechanism. Aim: The aim of the present study is to determine the relationship between single nucleotide polymorphism at G1691A position of Factor V gene and risk of ischemic stroke (IS) in North Indian population. Materials and Methods: In a retrospective case–control study, 250 patients with IS and 250 age‑ and gender‑matched controls were enrolled in the period of October 2012 to September 2014 from in‑ and out‑patient department of Neurology, All India Institute of Medical Sciences, New Delhi, India. Deoxyribonucleic acid for each case and control was isolated from peripheral blood using phenol‑chloroform extraction method. Polymerase chain reaction‑restriction fragment length polymorphism method was used to determine the polymorphism. Data were analyzed using STATA Software Version 13. Results: The mean age of IS patient was 52.8 ± 12.5 years and in control group was 50.97 ± 12.7 years. Genotypic frequency distributions were in accordance with Hardy–Weinberg equilibrium in both cases and controls. As expected hypertension, diabetes, dyslipidemia, smoking, heavy alcohol intake, family history of stroke, and poor economic status were significantly associated with the risk of IS. Multivariate analysis revealed 5.17 times higher odds for developing the risk of large vessel subtype of IS in patients carrying Factor V Leiden G1691A gene variation as compared to control subjects (OR, 5.17; 95% CI, 1.32–20.3, P = 0.01). Conclusion: The present study suggests that Factor V Leiden G1691A polymorphism may be significantly associated with the risk of large vessel subtype of IS. Large sample size studies using prospective cohort designs are required to corroborate the present findings. [ABSTRACT FROM AUTHOR]

Previously published studies that have examined whether the three polymorphisms, G894T, T786C, and 4b/a in the endothelial nitric oxide synthase (eNOS) gene, are associated with ischemic stroke (IS) have reported conflicting results. Thus, we performed a meta-analysis to examine the potential association between these three single nucleotide polymorphisms (SNPs) of the eNOS gene and IS risk. A literature search was carried out for eligible candidate gene studies published before August 05, 2015 in the PubMed, Embase, and Google Scholar databases. The following combinations of main keywords were used in our study: ('endothelial nitric oxide synthase') or ('eNOS') and ('G894T, 4b/a, and T786C') and ('polymorphism') or ('polymorphisms') and ('Ischemic Stroke' or 'IS') and ('Cerebral Infarction' or 'CI') and ('genetic polymorphism' or 'single nucleotide polymorphisms' or 'SNP'). Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were estimated by using fixed or random effects model. Meta-regression analysis was used to investigate the potential sources of heterogeneity. Begg's funnel plots were used to explore the publication bias, and heterogeneity was assessed by I2 test. Twenty seven case-control studies involving 6733 cases and 7305 controls were analyzed in our meta-analysis. Significant association was observed for G894T (OR = 1.17; 95% CI: 1.08 to 1.28; P< 0.001) and 4b/a (OR = 1.25; 95% CI: 1.13 to 1.39; P < 0.001) whereas a non-significant association was observed for T786C (OR = 1.11; 95% CI: 0.98 to 1.26; P =0.109) eNOS gene polymorphisms and IS. Our meta-analysis establishes that the G894T and 4b/a polymorphisms of eNOS gene are significantly associated with the risk of IS. However, a non-significant association was found between T786C polymorphism of the eNOS gene and IS risk. Further prospective large epidemiological studies need to be done to confirm these findings. [ABSTRACT FROM AUTHOR]

Stroke, a heterogeneous multifactorial disorder, is known to be a major cause of death and adult disability within both the developed and developing countries. Approximately 85% of stroke cases are ischemic, whereas the remaining 15% are hemorrhagic. It is caused by multiple genetic factors, environmental factors, and interactions among these factors. Several candidate genes have been found to be associated with ischemic stroke. The most extensively studied genes include those involved in hemostasis, inflammation, nitric oxide production, homocysteine and lipid metabolism, and rennin-angiotensin-aldosterone system. Combined linkage/association studies have demonstrated that genes encoding phosphodiesterase 4D (PDE4D) and arachidonate 5-lipoxygenase-activating protein (ALOX5AP) confer risk for stroke. Even though there is substantial evidence for the genetic basis of stroke as provided by the epidemiological data from twin- and family-based studies, the contribution of genetic factors identified till now is either not enough or very less to explain the entire spectrum of encountered phenomena associated with ischemic stroke. Till date, no genome-wide association studies (GWAS) have been carried out in India. We aim to extensively review the studies on candidate genes that may have potential applications in the early diagnosis, prevention, and treatment of ischemic stroke in the Indian population. This article further emphasizes the role of GWAS in ischemic stroke and the need for an extensive GWAS in the Indian population. [ABSTRACT FROM AUTHOR]

Background: Grading and hormone receptor determination in breast carcinoma are predictive factors for response to hormonal therapy. Aim: This study was undertaken to grade breast carcinoma and to determine estrogen receptor (ER) and progesterone receptor (PR) expression on fine-needle aspiration cytology (FNAC). Furthermore, the objective was to compare the results with histological grading and immunohistochemistry on surgical material. Materials and Methods: Fifty cases of breast carcinoma diagnosed on FNAC were included. The cytological grading was done according to the Robinson's grading system. The corresponding histology sections were graded using the modified Bloom-Richardson system. Immunostaining for ER and PR was done on smears and tissue sections. Results: On both cytological and histological evaluation, 49 cases were infiltrating ductal carcinoma and one case was colloid carcinoma. On comparing cytological and histological grading, 78% were correctly graded on cytology. The sensitivity, specificity, positive predictive value and negative predictive value for ER detection on immunocytochemistry (ICC) were 55.6%, 95%, 93.8% and 61.3%, respectively. The sensitivity, specificity, positive and negative predictive value for PR detection on ICC were 57.7%, 95.2%, 93.8% and 64.5%, respectively. The correlation for ER and PR between cytology and histology was 72.3% and 74.5%. Conclusion: The grading along with ER and PR immunostaining of breast carcinoma on smears is advocated because of high concordance between cytology and histology. This allows the patient to be treated with hormonal therapy on the basis of FNAC alone. [ABSTRACT FROM AUTHOR]

Autologous blood transfusion is defined as the collection of blood from the patient, either preoperatively or intraoperatively, and its transfusion back to the same patient as and when required. We report a case of a 23-year-old pregnant female, G3P1L1A1, presenting with severe Rh alloimmunization, along with a baby requiring intrauterine transfusion for fetal anemia, planned for elective cesarean section and autologous blood transfusion. [ABSTRACT FROM AUTHOR]

Background and Aims: Trigeminal neuralgia is a manifestation of orofacial neuropathic pain restricted to one or more divisions of the trigeminal nerve. This prospective study was conducted to compare the safety and efficacy of conventional versus pulsed versus combined radiofrequency ablation for treatment. Methods: The patients were divided in three groups of 20 each. In group I (n=20), patients were administered fluoroscope guided conventional radiofrequency ablation at 75°C and thermal lesion was applied for 270 seconds. In group II (n=20), patients were administered fluoroscope guided pulsed radiofrequency ablation for 10 minutes at 45 V, with a pulse width of 10 ms and a pulse frequency of 4 Hz at 42°C. In group III (n=20), patients were administered fluoroscopic guided conventional radiofrequency ablation followed by pulsed radiofrequency ablation. Patients were followed up for a period of three months. Results: Pain scores (visual analogue scale) were found comparable between the three groups at all the time points (p>0.05). Vital parameters like heart rate, systolic and diastolic blood pressures were also comparable amongst the three groups at different time points and showed no statistical significance (p>0.05). None of the patients reported any serious complications. Conclusion: All the three procedures, conventional radiofrequency, pulsed radiofrequency and combined conventional and pulsed radiofrequency are safe and effective techniques for management of patients with trigeminal neuralgia, with comparable efficacy. All the techniques provide good pain relief and improvement in disability to the patients. [ABSTRACT FROM AUTHOR]

Multiple casualties and the complex set of injuries in survivors of a terrorist bomb blast poses a real challenge to health care providers. We are presenting three such cases, first case suffered a fracture of both bone lower limb bilaterally along with head injury (foreign bodies were impacted in the scalp and brain parenchyma). Following primary resuscitation, patient shifted to operation theatre after a quick computerized tomography scan and external fixator applied in general anesthesia using the rapid sequence induction. No active neurosurgical intervention was done. As this patient had acute post-traumatic stress response, he was subjected to low pressure hyperbaric oxygen therapy (pressure of 1.5 ATA for 60 min a day for 10 days) and group counseling. He had good recovery except one lost a limb because of extensive neurovascular damage due to blast. Second case had much more extensive damage involving multiple organ systems. He had blast lung, big cerebrovascular hemorrhage along with gut perforation. Despite best possible surgical and intensive care interventions, patent developed multiple organ failure and unfortunately we lost our patient. Third case was of a right sided globe rupture resulted from blast induced lying foreign bodies. After primary survey and initial resuscitation evisceration done for the damaged eye and patient later on discharged with necessary instruction (including warning signs) for follow-up. [ABSTRACT FROM AUTHOR]

Background: Stroke is a multifactorial, polygenic disorder, influenced by both environmental and genetic factors. Aim: The purpose of this study was to determine the association of beta-1 and beta-2 adrenergic receptor (AR) polymorphisms with intracerebral hemorrhagic stroke (ICH) in a North Indian population. Materials and Methods: One hundred and six patients with intracerebral hemorrhage (ICH) and 106 age- and sex-matched controls were recruited. Genotyping was performed by using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. RFLP results of three samples of each genotype were confirmed by DNA sequencing. Results: Mean age of cases and controls were 53.47 ± 14 and 52.92 ± 13.4, respectively. Significant association between Ser49Gly polymorphism of beta-1 AR and ICH in patients who had onset of disease at a later stage of life (>50 years) under a dominant model of inheritance (OR, 3.6; 95% 1.4 to 9.7) was observed. Under the dominant model of inheritance, Gln27Glu polymorphism of beta-2 AR was associated with risk of ICH (OR, 3.2; 95% CI, 1.7 to 5.8) and significant association persisted even after adjustment for demographic and other risk factor variables (OR, 2.9; 95% CI, 1.04 to 8; P = 0.04). Age-stratified analysis showed an independent significant association of Gln27Glu polymorphism of beta-2 AR with risk of ICH in patients those had onset of disease at young age (<50 years) under a dominant model of inheritance (OR, 3.5; 95% CI, 1.1 to 11). Conclusion: The present study provides the first preliminary evidence that Gln27Glu polymorphism of beta-2 AR may contribute modest effect in increase in risk of ICH in North Indian Population. Large prospective studies with large sample size are required to confirm these findings. [ABSTRACT FROM AUTHOR]

Objective: Sevoflurane and propofol are considered to be the agents of choice in surgeries of short duration due to their better recovery profile and few post-operative complications. This study was designed to compare the early recovery profile of sevoflurane and propofol anesthesia in patients undergoing open cholecystectomy. Materials and Methods: A total of 60 patients of either sex with American Society of Anesthesiologists grade 1 and 2 scheduled for elective cholecystectomy were prospectively randomized into two groups. Group S (30 patients) were maintained with sevoflurane anesthesia (1-2%), while in Group P (30 patients) were maintained with propofol infusion (75-125 ìg/kg/min) in both the groups the anesthetic concentration/dose was so adjusted to keep hemodynamic parameter (mean arterial pressure and heart rate) within 15% of their respective baselines values. Results: It was observed that there was no significant difference (P > 0.05) between there early recovery profile that includes spontaneous eye opening (7.5 ± 1.6 min for sevoflurane group and 6.9 ± 1.7 min for propofol group), following simple verbal command (9.2 ± 2.2 min for sevoflurane group and 8.9 ± 1.9 min for propofol group) and extubation time (10.7 ± 2.3 min for sevoflurane group and 10.3 ± 2.0 min for propofol group) but there was a significant difference (P < 0.05) in incidence of post-operative nausea and vomiting (PONV) in both groups. Conclusion: Propofol is as good as sevoflurane for maintenance of anesthesia in surgeries like open cholecystectomy with an added advantage of lower incidence of PONV owing to its intrinsic antiemetic properties. [ABSTRACT FROM AUTHOR]

Aim: The study aims to develop simple, sensitive, rapid, accurate and precise spectrophotometric method for estimation of Zolpidem tartrate in tablet dosage forms. Materials and Methods: For method I, II, III and IV in a series of 10 ml volumetric flask, aliquots of standard drug solution (100 μg/ml) in 0.1N HCl were transferred and diluted with same so as to give several dilutions in concentration range of 5-30 μg/ml, 5-30 μg/ml, 10-50 μg/ml and 5-40 μg/ml respectively of zolpidem tartrate. To 5 ml of each dilution taken in a separating funnel, (5 ml of bromo phenol red, bromo cresol purple, bromo cresol green and bromo phenol blue for method I, II, III and IV respectively) reagent and 5 ml of chloroform was added. Reaction mixture was shaken gently for 5 min and allowed to stand so as to separate aqueous and chloroform layer. Absorbance maxima measured at 407 nm, 417 nm, 412 nm and 415 nm for method I, II, III and IV respectively. Results: The recovery studies were found close to 100 % that indicates accuracy and precision of the proposed methods. The statistical analysis was carried out and results of which were found satisfactory. Standard deviation values were found low that indicated reproducibility of the proposed methods. Conclusion: Based on results the developed methods could be used for routine estimation of zolpidem tartrate from tablet formulations. [ABSTRACT FROM AUTHOR]

A 32 year female presented with easy fatiguability, asthenia and generalised swelling of 8 years duration. Past history revealed a home delivery 8 years back complicated with post partum haemorrhage. Lactation failure and secondary amenorrhoea followed this delivery. Examination revealed a delayed ankle reflex. Hormonal profile suggested panhypopituitarism. A diagnosis of Sheehan's syndrome was made. Sheehan's syndrome, a rare complication of post-partum haemorrhage, is often missed and mean duration between start of disease and diagnosis usually is 5-8 years. Hence, a high index of suspicion and awareness of this entity is important. [ABSTRACT FROM AUTHOR]

Background: Spontaneous intracerebral hemorrhage (SICH) accounts for 7.5%-30% of all strokes and carries higher morbidity and mortality. Raised blood urea nitrogen and creatinine ratio (BUNR) is a marker of dehydration and related to poor outcome in stroke patients. However, the ratio varies between 15 and 80 in different studies. The aim of the present study was to assess BUNR as an independent predictor of mortality and its sensitivity and specificity in predicting outcome in the SICH population.Materials and Methods: Patients above the age of 18 years with SICH who were admitted in the Department of Neurology at Sir Sunderlal Hospital, Banaras Hindu University between January 2018 and July 2020 were enrolled in the study and prospectively followed up. Demographic, clinical, radiological, and outcome parameters were recorded.Results: A total of 217 patients were included. Of these, 137 (63%) were males. Seventy-one patients died during the initial 30 days. Number of patients with intraventricular hemorrhage (IVH; P = 0.003), higher mean intracerebral hemorrhage (ICH) volume (P < 0.001) and midline shift (P = 0.021), and poor Glasgow Coma Scale (GCS) score (<9) (P = 0.040) was more in the group which did not survive. Mean level of urea was significantly lower among survivors than in those who died (P = 0.001). BUNR was also significantly higher in those who died than in those who survived (P = 0.001). BUNR with a cutoff value of 39.17 was significantly associated with mortality at 30 days with a sensitivity and specificity of 61.97% and 62.33%, respectively. On performing two different multivariable logistic studies, it was found that model B with BUNR ratio as a predictor of mortality out performed model A (without BUNR).Conclusions: The study showed that SICH was associated with significant mortality. Independent predictors of death at 30 days were lower GCS on admission, larger hematoma volume, and BUNR of more than 39.17. [ABSTRACT FROM AUTHOR]

Background and Aims: The presence of gastric content increases the risk of aspiration during general anesthesia. Diabetic patients have delayed gastric emptying; however, despite adequate fasting because of diabetic gastroparesis these patients have a high risk of aspiration. This study aimed to compare ultrasound‑guided measurement of residual gastric volume between diabetic and non‑diabetic patients scheduled for elective surgery under general anesthesia. Methods: This prospective observational study included 80 patients divided into two groups of 40 diabetic patients with a minimum of 8 years history of diabetes and 40 nondiabetic patients aged >18 years, American Society of Anesthesiologists’ physical status I–II kept with similar fasting intervals. Before induction of general anesthesia, gastric ultrasound was performed using standard gastric scanning protocol to measure craniocaudal (CC) and anteroposterior (AP) diameters followed by calculation of antral cross‑sectional area (CSA) and gastric volume in semi‑sitting (SS) and right lateral decubitus (RLD) position using curved array probe. The gastric antrum volume (GV) was classified as Grade 0, 1, or 2, and risk stratification for aspiration was done. The nasogastric tube was inserted after induction of anesthesia to aspirate and compare the gastric content. Results: In the semi‑sitting position, the mean CC and AP diameters were 16.38 ± 3.31 mm and 10.1 ± 2.53 mm in the non‑diabetic group and 25.19 ± 4.08 mm and 15.8 ± 3.51 mm in the diabetic group, respectively. In RLD, CC was 1.91 ± 0.38 cm and AP was 1.19 ± 0.34 cm in the non‑diabetic group as compared to the CC of 2.78 ± 0.4 cm and AP of 1.81 ± 0.39 cm in the diabetic group. The calculated CSA of 318.23 ± 97.14 mm² and 4 ± 1.1 cm² in diabetic were significantly higher than 133.12 ± 58.56 mm² and 1.83 ± 0.83 cm² of non‑diabetic, in SS (p < 0.0001) and RLD (p < 0.0001) positions, respectively. The GV of 15.48 ± 11.18 ml in the diabetic group was significantly higher than (‑) 9.77 ± 18.56 ml in the non‑diabetic group (p < 0.0001). Despite the differences in CSA and GV between diabetic and non‑diabetic groups, both groups showed a low gastric residual volume (<1.5 ml/kg). The gastric tube aspirate in the non‑diabetic and diabetic groups was 0.3 ± 0.78 ml and 1.24 ± 1.46 ml, respectively, and was statistically significant (p = 0.0006). Conclusion: Patients with long‑standing diabetes showed higher gastric residual and antral CSA when compared with non‑diabetic patients. The clinical significance of these findings needs further evidence for the formulation of specific guidelines for diabetic patients. [ABSTRACT FROM AUTHOR]