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Background: Poor long-term adherence and persistence to pharmacological therapy is widely acknowledged as one of the primary clinical difficulties in the management of chronic diseases such as chronic kidney disease (CKD). The present study was aimed to measure treatment adherence using the Morisky Medication Adherence Scale (MMAS)-8 questionnaire in CKD patients with or without hemodialysis. Methodology: It was a cross-sectional study conducted in 120 clinically stable CKD patients with Stage 3 onward with or without hemodialysis. The sociodemographic and clinical characteristics of participants were collected in a predesigned format. Individual participants were scheduled for interviews and asked to complete inventory questionnaires. Medication adherence was assessed using a validated diagnostic tool MMAS-8 questionnaire. Results: Out of 120 individuals, the average number of medicines prescribed per prescription was 5.63 ± 2.22 and 4.65 ± 1.72 in the dialysis and nondialysis groups, respectively. Patients on dialysis had a higher pill burden than nondialysis patients, with more than three-fourths (78.3%) of them taking more than five medications every prescription. Low, moderate, and good adherence were reported in 61.7% (n = 37) versus 26.7% (n = 16), 33.3% (n = 20) versus 71.7% (n = 43), and 5% (n = 3) versus 1.6% (n = 1) of patients with and without dialysis, respectively, in MMAS-8. The most often reported nonadherence behaviors were forgetting to take medications, forgetting to pack medications while traveling, and feeling pressured to follow a treatment plan. There was an association between the dialysis and nondialysis groups in education level, employment, and pill load among patients with low adherence. Conclusion: Majority of the respondents (more than 90%) reported low-to-moderate adherence in both dialysis and nondialysis populations. Physicians and all other health-care professionals should work together to reduce the obstacles to good adherence by enhancing communication, reducing the burden of taking a lot of pills, and, if possible, by occasionally checking on patient adherence when there is suspicion of poor adherence. [ABSTRACT FROM AUTHOR]

There is conflicting evidence regarding the analgaesic efficacy of single-shot serratus anterior plane block (SAP) for breast surgery. This meta-analysis aimed to evaluate the analgaesic efficacy of SAP compared with non-block care (NBC) and other regional blocks, i.e. paravertebral block (PVB) and modified pectoral nerve block (PECS block) for breast surgery. PubMed, Embase, Scopus, the Cochrane Central Register of Controlled Trials and ClinicalTrials.gov were searched. We included randomized controlled trials reporting the use of the SAP block in adult breast surgery. The primary outcome was postoperative oral morphine equivalent (OME) consumption for up to 24 hours. Random-effects models were used to pool results and mean difference (MD), and odds ratio (OR) was calculated for continuous and dichotomous outcomes, respectively. GRADE guidelines were used to evaluate the strength of evidence, and trial sequential analysis (TSA) was performed to provide certainty to the conclusion. Twenty-four trials enrolling 1789 patients were included. Moderate strength evidence suggested that SAP provided a significant reduction in 24-hour OME compared with NBC [MD - 24.9 mg (95% CI - 41.54, -8.25; P < 0.001, I2 = 99.68%)]. TSA ruled out the possibility of false-positive results. Subgroup analysis for the SAP demonstrated that the superficial plane approach was more effective in reducing opioid consumption than the deep approach. The odds of developing PONV were significantly lower in SAP compared to NBC. Compared with PVB and PECS, SAP block was not statistically different for 24-hour OME and time to first rescue analgaesia. Single-shot SAP reduced opioid consumption, prolonged analgaesia duration, lowered pain scores, and decreased the incidence of PONV compared to NBC. There was no statistically significant difference in the studied endpoints between SAP, PVB, and PECS blocks. [ABSTRACT FROM AUTHOR]

Background: Frailty is a common clinical syndrome in the elderly that may be associated with increased risk of health complications and decreased physical functioning. Early screening of individuals who are at high risk of frailty is required to allow timely intervention for the prevention and reversal of frailty. There is a paucity of information on frailty among the Indian elderly population and especially among the elderly chronic kidney disease (CKD) population. Hence, the aim of the present study was to find out the occurrence of frailty in elderly patients with CKD. Methods: The present prospective cross-sectional study was conducted from an outpatient clinic of a tertiary care hospital. We enrolled 200 participants aged 60 years or above, dividing them into two groups as case (included those with CKD stage 3 and above who were not on dialysis with or without any coexisting comorbidities) and control groups (included those non-CKD patients with or without any coexisting comorbidities). Exclusion criteria were patients with prior history of stroke with neurological complications, dementia or cognitive deficit, severe Parkinson's disease, and nonambulatory. Assessment of frailty was done using the short physical performance battery test (SPPBT) and handgrip strength (HGS). Assessment of HGS was done using a JAMAR hand dynamometer. The data were analyzed using SPSS V 20.0. Results: Majority of the participants were male in the case group (58%), while they were almost equal in the control group (51%). Most of the participants belonged to the age groups of 60–70 years with a mean age of 68.8 ± 5.90 years and 67.99 ± 5.93 years in case and control groups, respectively. In the case group, more than half of the patients had CKD stage 4 (57%), followed by CKD stage 5 (36%). There was no significant difference in diabetes mellitus (P = 0.41), hypertension (P = 0.63), malignancy (P = 1.0), CLD (P = 0.097), and thyroid disorder (P = 0.85) among the groups. Using SPPBT, frailty was found to be significantly higher in CKD patients in comparison to control (78% vs. 62%, P = 0.014). Using the HGS criteria, frailty was detected almost similar in both the groups (CKD vs. non-CKD; 77% vs. 78%, P = 0.866). Frailty was found to be high (78.5%) in CKD patients who had estimated glomerular filtration rate of <30 ml/min. Moreover, frailty was significantly higher in those with diabetes with CKD than diabetic alone (P = 0.009). Conclusion: Frailty was found to be high in elderly patients with CKD as compared to the non-CKD population. This indicates a need for continuous assessment of frailty and timely tailored intervention for prevention and reversal of frailty in the elderly CKD population. [ABSTRACT FROM AUTHOR]

Background and Aims: Modified pectoral nerve block (PEC) has been reported to have variable effects on perioperative pain in patients undergoing surgery for carcinoma breast. This randomised controlled trial was conducted to study the effect of modified PEC on postoperative pain relief in patients undergoing breast surgery. Methods: Fifty patients with carcinoma breast undergoing breast surgery were randomised to receive a modified PEC block consisting of 30 ml of ropivacaine 0.2% after induction of anaesthesia (PEC group) or no block (GA group) in this prospective randomised trial. Time to first rescue analgesia was recorded as primary outcome. Other secondary outcomes recorded were postoperative visual analogue scale (VAS) scores, number of rescue boluses and 24-h fentanyl consumption. Results: There was no significant difference in time to first rescue analgesia between the two groups, with mean difference (95% confidence interval) of 22.91 (−6.8 to 52.69) min. Amount of fentanyl required to keep pain VAS less than 3 was also comparable between the two groups, mean (standard deviation) of 42.0 μg (17.42) in GA group versus 43.24 μg (17.22) in PEC group; P = 0.830.20/25 patients required rescue analgesia in GA group as compared to 17/25 in PEC group (P = 0.334). The postoperative VAS scores were also comparable between the groups at all time intervals. Conclusion: Balanced anaesthesia supplemented with modified PEC block performed after general anaesthesia did not improve the postoperative pain in patients undergoing modified radical mastectomy. [ABSTRACT FROM AUTHOR]

Background: Acute kidney injury (AKI) has both short term as well as long-term consequences in critically ill patients. The present study is an attempt to study its etiological profile in intensive care units (ICUs) which has been only scarcely done in India. Methods: One hundred and twenty patients admitted with or developing AKI during their ICU stay were included in the prospective study and were defined as well as staged according to the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. Patients were followed up at discharge and at 3 months to determine the outcome as either favorable (renal recovery) or adverse (residual renal dysfunction, dialysis dependence, or death). Various known risk factors, as laid down by KDIGO, were identified and analyzed with respect to their association with the outcome. Results: Out of total of 120 subjects, almost half of the subjects (47.5%) had Stage I AKI, 27.5% had Stage II AKI and the remaining quarter of subjects had Stage III AKI. One fourth had pre-existing chronic kidney disease and three-fourth subjects had developed de novo AKI of which more than half of patients had community-acquired AKI. Anemia and sepsis were the most prevalent risk factors. The highest rate of renal recovery was demonstrated in Stage I AKI. Overall mortality was 28%, highest in Stage III AKI. Conclusion: The study demonstrated increasing prevalence of the adverse outcome in a linear fashion with an increase in the severity of AKI. Sepsis was not only the most prevalent risk factor but was also strongly associated with an adverse outcome. The epidemiology of AKI in critical care in India has started to resemble high-income group countries, in terms of both age distribution as well as etiology. [ABSTRACT FROM AUTHOR]

Background: Acute kidney injury (AKI) has both short term as well as long-term consequences in critically ill patients. The present study is an attempt to study its etiological profile in intensive care units (ICUs) which has been only scarcely done in India. Methods: One hundred and twenty patients admitted with or developing AKI during their ICU stay were included in the prospective study and were defined as well as staged according to the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. Patients were followed up at discharge and at 3 months to determine the outcome as either favorable (renal recovery) or adverse (residual renal dysfunction, dialysis dependence, or death). Various known risk factors, as laid down by KDIGO, were identified and analyzed with respect to their association with the outcome. Results: Out of total of 120 subjects, almost half of the subjects (47.5%) had Stage I AKI, 27.5% had Stage II AKI and the remaining quarter of subjects had Stage III AKI. One fourth had pre-existing chronic kidney disease and three-fourth subjects had developed de novo AKI of which more than half of patients had community-acquired AKI. Anemia and sepsis were the most prevalent risk factors. The highest rate of renal recovery was demonstrated in Stage I AKI. Overall mortality was 28%, highest in Stage III AKI. Conclusion: The study demonstrated increasing prevalence of the adverse outcome in a linear fashion with an increase in the severity of AKI. Sepsis was not only the most prevalent risk factor but was also strongly associated with an adverse outcome. The epidemiology of AKI in critical care in India has started to resemble high-income group countries, in terms of both age distribution as well as etiology. [ABSTRACT FROM AUTHOR]

Background and Aims: Post‑operative sore throat (POST) is a common undesirable consequence of tracheal intubation. Magnesium, an N‑methyl‑D‑aspartate receptor antagonist, has anti‑nociceptive and anti‑inflammatory properties, and has been found to be useful in POST prevention in various trials. We conducted this systematic review and meta‑analysis to study the efficacy of topical magnesium in preventing POST in adult patients undergoing surgery under general anaesthesia with single lumen tracheal tube. Methods: Comprehensive literature search was performed in PubMed, Google Scholar, EMBASE, Scopus and the Cochrane central registers of controlled trial databases through July, 2018 and data were pooled using fixed effect modelling followed by random‑effect methods (after assessing heterogeneity with fixed modelling). The primary outcome was the incidence of POST at 24 h after surgery/extubation. Comparative results were deliberated as pooled mean difference for continuous variables and Mantel–Haenszel (MH) odds ratio for dichotomous variables. Statistical analysis was done using Comprehensive Meta‑Analysis‑Version 3 (Biostat Inc., USA). Results: Seven trials involving 726 study participants were included in the final analysis. Incidence of POST at 24 hours was significantly lower in magnesium group (26/363) in comparison to active and non‑active control group (89/363); P = 0.00‑ RR 0.22 (95%CI = 0.12‑0.39, I² = 0%). No significant adverse events were reported with the use of topical magnesium. Conclusion: Prophylactic use of topical magnesium before the induction of general anaesthesia seems to be an effective measure to decrease the incidence of POST. [ABSTRACT FROM AUTHOR]

Introduction: Auto-rickshaw driver is exposed to many kinds of risks owing to his profession, such as stressful occupational conditions, environmental pollution, and drug abuse such as smoking, tobacco, and alcohol use. The present study is an attempt to estimate the prevalence of substance abuse and depression among auto-rickshaw drivers and compare these with nonauto-rickshaw drivers. Subjects and Methods: A total of 120 participants were enrolled randomly in the study, i.e., 60 each from auto-rickshaw drivers and nonauto-rickshaw population. To fulfill the objective, methodology based on the test application of the Beck's Depression Inventory, Hamilton Anxiety Rating Scale, and alcohol, smoking, and substance involvement screening test was used. A predesigned questionnaire was used that included information such as general health status, habits, addictions, and work experience. To establish statistical relationships between two or more random variables, the Pearson correlation coefficient was also calculated. Results: In the present study, significant high prevalence of tobacco and alcohol use was seen among auto drivers, 83.3% and 63.3% as compared to nonauto-rickshaw drivers (tobacco and alcohol, 46.6% and 46.1%, respectively). The prevalence of depression in auto-rickshaw drivers was 90% (mild-to-severe range) which was significantly high compared to nonauto-rickshaw drivers (60%). On the Hamilton Anxiety Rating Scale, more than half of the auto-rickshaw drivers, i.e., 60%, had mild-to-moderate anxiety which was higher than nonauto-rickshaw (5%). Driving experience, age, and substance abuse (alcohol and tobacco use) showed a significant association with depression. Conclusion: This study demonstrated a high prevalence of depression, anxiety, and substance abuse in auto-rickshaw drivers. There was a positive correlation of depression with substance abuse (alcohol and tobacco), age, and work experience. This study will assist the psychologist to understand and treat the mental health issues among professional drivers. [ABSTRACT FROM AUTHOR]

Background: Communication skills play an important role in establishing doctor-patient relationship is widely recognized throughout the world. The information passed on to the patients affects the treatment outcomes. Objectives: The present study was undertaken to evaluate the level of awareness among OPD patients about prescribed drugs. Materials and Methods: A total of two hundred sixty four patients having a valid prescription from a doctor practicing in allopathic system, visiting 4 different chemist shops in a North Indian city were enrolled in the study. All the enrolled patients were given a preformed questionnaire to be answered on the spot. Results: It was found that though a considerable number of patients were aware about the therapeutic effects of the drugs and the manner of administration of the medicines; they lacked information regarding the side effects, warnings and the information their doctor may require at the next consultation. Conclusion: The study highlighted the fact that doctors need to spend more time with the patients to make them active participants in the drug therapy. [ABSTRACT FROM AUTHOR]

Objective: To estimate the prevalence of metabolic syndrome among adolescents attending school in the Jammu region, India. Materials and Methods: This is a cross-sectional study conducted between November 2009 and December 2010, among a total of 1160 school-going adolescents of both sexes aged 10-18 years. Relevant metabolic and anthropometric variables were analyzed and criteria suggested by National Cholesterol Education Program Adult Treatment Panel Third (NCEP-ATP III) modified for age was used to define metabolic syndrome. Results: The overall prevalence of metabolic syndrome was 2.6%. Prevalence of metabolic syndrome was higher in males (3.84%) than in females (1.6%) and slightly higher in urban area (2.80%) than in rural area (2.52%), whereas prevalence of metabolic syndrome among centrally obese subjects was as high as 33.33%. High density lipoprotein cholesterol was the most common and high blood pressure was the least common constituent of metabolic syndrome. Metabolic syndrome was most prevalent in 16-18 years age group (4.79%). Conclusion: This study demonstrates that metabolic syndrome phenotype exists in substantial number (up to 3%) of adolescent population in the Jammu region, India, and particularly 33% of obese adolescents are at risk to develop metabolic syndrome. These findings pose a serious threat to the current and future health of these young people. [ABSTRACT FROM AUTHOR]

Randomised controlled trials are considered the state of the art in the intervention/experimental research designs. However, they are not easy to conduct and have a number of aspects to be looked into. The various types of randomised controlled trials, their characteristics, the process of randomisation, allocation concealment and advantages and drawbacks of randomised controlled trials have been outlined in this article. [ABSTRACT FROM AUTHOR]

Objective: To investigate the in vitro antioxidant activity of different fractions (R1, R2 and R3) obtained from pet ether extract of black pepper fruits (Piper nigrum Linn.) Materials and Methods: The fractions R1, R2 and R3 were eluted from pet ether and ethyl acetate in the ratio of 6:4, 5:5 and 4:6, respectively. 1,1-Diphenyl-2-picryl-hydrazyl (DPPH) radical, superoxide anion radical, nitric oxide radical, and hydroxyl radical scavenging assays were carried out to evaluate the antioxidant potential of the extract. Results: The free radical scavenging activity of the different fractions of pet ether extract of P. nigrum (PEPN) increased in a concentration dependent manner. The R3 and R2 fraction of PEPN in 500 μg/ml inhibited the peroxidation of a linoleic acid emulsion by 60.48±3.33% and 58.89±2.51%, respectively. In DPPH free radical scavenging assay, the activity of R3 and R2 were found to be almost similar. The R3 (100μg/ml) fraction of PEPN inhibited 55.68±4.48% nitric oxide radicals generated from sodium nitroprusside, whereas curcumin in the same concentration inhibited 84.27±4.12%. Moreover, PEPN scavenged the superoxide radical generated by the Xanthine/Xanthine oxidase system. The fraction R2 and R3 in the doses of 1000μg/ml inhibited 61.04±5.11% and 63.56±4.17%, respectively. The hydroxyl radical was generated by Fenton's reaction. The amounts of total phenolic compounds were determined and 56.98 μg pyrocatechol phenol equivalents were detected in one mg of R3. Conclusions: P. nigrum could be considered as a potential source of natural antioxidant. [ABSTRACT FROM AUTHOR]

Mesenchymal soft tissue masses are uncommon tumours of the chest. Myofibroblastoma is a recently described entity consisting of cells with origin from the myoepethelial cell, mostly seen as benign well-circumscribed neoplasms of the breast tissue. Though usually classified as a benign lesion, rarely it can be multifocal and prone to recurrence. We describe below the case of a 26-year-old female who presented with exertional dyspnoea and evidence of a massive mass lesion in the left hemithorax causing mediastinal displacement to the opposite side. On histological and immunophenotypic analysis, a diagnosis of the very rare thoracic myofibroblastoma was made. The incidence, salient features, pathological differential diagnoses and treatment are reviewed. [ABSTRACT FROM AUTHOR]

A rare case of traumatic perforation of the ileum in a neonate due to mauling by wild monkey from a hilly area is reported. The patient presented with features of septicemia, bilious vomiting, abdominal distention and signs of peritonitis. Exploratory laparotomy with closure of the perforation was performed and the baby survived. After thorough and careful review of available English literature, we found no similar case and this forms the basis of present publication. [ABSTRACT FROM AUTHOR]