Search

Aim: This study was conducted to find out the incidence of obstetric hysterectomy and to study and analyze indications, risk factors, complications, morbidity, and mortality in both mother and fetus associated with obstetric hysterectomy. Methods: It is an observational prospective study conducted at Government Medical College & Hospital, Aurangabad, Maharashtra, India with cases of obstetric hysterectomy done from the conception of pregnancy till the end of puerperium over 2 years. Result: During the study period, there were 43768 confinements out of which 55 cases underwent obstetric hysterectomy giving an incidence of 0.13%. Incidence following vaginal delivery was 0.05% and following cesarean section was 0.30%. The most common indication was morbidly adherent placenta (50.90%), followed by uterine atony (36.36%) and rupture uterus (14.55%). 63.64% had previous cesarean deliveries as a risk factor. Maternal mortality was 9.09% cases. 63.60% of babies went home alive. Conclusion: Caesarean section and its sequel like morbidly adherent placentae have changed the trend and topped now as an indication of obstetrics hysterectomy.

Background: Twin gestation has always fascinated mankind throughout history; and its management is potential challenging for an obstetrician. Increasing maternal age at childbirth, use of ovulation induction drugs and assisted reproductive technologies has increased significantly the incidence of multiple fetal gestations. In India, the estimated incidence of twin pregnancy is 9–16 per 1000 births. With multiple gestation, than singleton ones, pregnancy induced maternal complications occur three to seven times more often. Prematurity, growth restriction, congenital anomalies, twin to twin transfusion, birth asphyxia, birth trauma, still birth are the problems faced by the multiples. The knowledge of maternal complications in multiple gestations will help in better maternal surveillance and prevent and treat the complications to improve the maternal and perinatal outcome. Objectives: To study the incidence of multiple gestation, obstetrical complications, maternal and foetal outcome in multiple pregnancies at a tertiary care centre. Methods: It was a retrospective observational study conducted in the department of Obstetrics and Gynaecology, at Govt medical college and hospital, Aurangabad, tertiary care Hospital, from October 2015 to October 2017. The data retrieved from the medical records on the multiple pregnancies included demographic data, complications of pregnancy, and maternal and neonatal outcomes. Appropriate Statistical analysis was performed. Results: Of 533 multiple gestations, after considering the inclusion and exclusion criteria, 500 cases were found eligible for study giving percentage of 1.4% birth. Median gestational age at delivery was 37 weeks. Most common maternal complication was anaemia (32%). Other maternal complications were preterm labour (19.6%), premature rupture of membranes (8.8%), pregnancy induced hypertension (8%), ante partum haemorrhage (0.4%), and postpartum haemorrhage (7.2%). 50.8% cases were delivered by caesarean section. 44.5% neonates had preterm delivery and prematurity was the most common cause of neonatal death. Neonatal death rate was 11%. Conclusion: Twin pregnancy has high maternal and neonatal complications, especially preterm delivery that increases risk of significant neonatal morbidity and mortality.

Background: Adolescent is age between 11-19 years, where there are enormous physical, psychological, sexual, emotional and behavioural changes. They constitute 22 % of population in India. Hence, their unique problems need to be addressed. Objectives: 1) To study gynaecological problems and their clinical profile in adolescent girls. 2) To evaluate treatment modalities of gynaecological problems in adolescent girls. 3) To evaluate reproductive health awareness among adolescent girls. Methods: Girls in the age group of 11 to 19 years attending gynaecology OPD or emergency were included in the study. First, the girl was interviewed keeping her privacy and dignity. A detailed history and examination were done emphasizing on pubertal events such as thelarche, pubarche, pregnancy and menarche. Investigations like hemogram, coagulograms, hormonal assays, and sonography were done wherever applicable. Results: 71.67% achieved menarche at 14-16 years of age. Most common gynaecological problems among the adolescent girls were menstrual disorders 156 (52%), followed by vaginal discharge i.e. 35(11.6%), 24(8.0%) gave history of sexual assault, 24 (8%) had excessive weight gain and 20(6.6%) reported urinary tract infection. The most common type of menstrual disorder was that of oligomenorrhea 86 (55.2%). Out of 38 PCOS cases, 31(81.6%) cases presented with oligomenorrhea. Out of 300 cases, 200(66.7%) cases were aware of physical signs of puberty, 245(81.7%) cases were aware of STD, HIV and its mode of transmission, 200(66.7%) cases were aware about contraceptive methods, 150(50.0%) cases were aware about physiology of menstruation and 198(66.0%) cases were aware of menstrual hygiene. Out of 19 teenage pregnancies, in 8(42.1%) cases LSCS was done, 4(21.3%) cases had vaginal delivery and 4(21.0%) cases had MTP. Conclusions: Menstrual abnormalities are the most common gynaecological problems of adolescents. Adolescents should be addressed with dignity. It is need of the time to set up specialized adolescent gynaecological clinics.

Background: It is an art and skill to surgically remove large and difficult fibroid & hysterectomies. This case series mentions variety of fibroids at different ages including pregnancy & numerous ways of surgically handling them successfully. Objectives: To study various surgical challenges and ways to overcome them in fibroids. Method: Total 10 cases with challenging surgeries were studied at Govt Medical College Hospital, Aurangabad from May 2018 to May 2019. Demographic details, presenting complaints, clinical examination findings, imaging techniques, investigations and operative difficulties and measures to prevent complications were studied. Results: Some presurgical techniques like preoperative use of GNRH analogue, preoperative stenting of ureter, anaemia correction and intraoperative techniques like hemi section of uterus, enucleating the fibroid using correct surgical plane, identifying ureter and surgical expertise helped to avoid all complications in surgery. Conclusions: Knowledge of altered anatomical structures, meticulous surgery by an expert following all surgical principles in fibroid surgery prevent injuries to the urinary tract, reduce blood loss and make surgery successful.

Extensive burns are severe form of trauma causing a great threat to life. Approximately 300,000 deaths is attributed to burns annually, majority (>95%) of which occur in developing countries. Survival rate of patients decreases as the rate of burn increases. Coronavirus disease (COVID-19) pandemic has affected all the communities worldwide. It has strong infectivity and high transmission rate. When treating corona-virus-infected burns patients, prevention of cross infection to health workers becomes of utmost importance. Here, authors present a case of extensive burns along with COVID-19 infection, the precautions taken to prevent infection among health workers and protocols followed for management. The patient was treated over a span of 75 days where the patient was cured of COVID-19 in 21 days and underwent two surgeries with homograft and autograft application. Multidisciplinary approach with strict protocols of safety and vigilant monitoring is key to successful management.

Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most common red cell enzymopathy found in humans. It clearly has an X-linked recessive inheritance with its prevalence varying from 0% to 27% in a different caste, ethnic, and linguistic groups. This deficiency may result in hemolytic anemia during stress, infection, and use of certain drugs. The use of topical silver sulfadiazine can produce hemolysis in patients having G6PD deficiency. Here, we describe one case successfully treated of pediatric burn of 25% of body surface area who was a known case of G6PD deficiency.

Domestic burns in neonate are rare in literature. Neonates are high risk for burns because of their thin and fragile skin, fluid overload or dehydration as the fluid balance range is small and immature immune system leading to septicaemia. Neonates are not small adults, owing to their different physiological response makes the management of neonates challenging as the clinical signs are different from the adults and the resuscitation protocols or end points are also different. We present a case of 11 days old neonate, who sustained 51% scald burns when the hot water bag being used by her mother accidentally burst, the youngest reported case of domestic scald burns with such high percentage. The baby was managed by fluid resuscitation, antibiotics, dressings, ventilatory support for septicaemia and subsequently homograft application. The neonate was discharged with completely healed areas after 35 days of burns and is on regular follow up and no complications have been observed.

Various traditional methods, including Dhoopana and Havana, have been employed in fumigation procedures to reduce microbial levels in the environment to nonpathogenic thresholds. Although the use of formaldehyde in combination with potassium permanganate is widely acknowledged as the predominant fumigation method, it is also associated with various health risks. In the present study the herbal dhoop stick was manufactured. In the manufacturing process of Dhoop sticks, various ingredients such as neem, tulsi, Kapoor, cow dung, cow urine, cow ghee, and guggul were meticulously combined in different quantities. The evaluation of the anti-microbial properties of the prepared dhoop stick by dhoopan was done on the nutrient agar plates in the kitchen area of hospital for three days. An assessment of number of colonies before and after the administration of dhoopstick revealed reduction in the mean score from 2480.66±72.94 cfu/100cm2 to 1938.66±144.57 cfu/100cm2 which was statistically significant (p-p-0.020447). Additionally, it was found that There was no significant difference found between after scores of both dhoopstick and formaldehyde (p-0.103734). Both the Dhoop Stick and formaldehyde exposures show a consistent reduction in microbial colony counts on agar plates in the hospital kitchen over the three-day period. [ABSTRACT FROM AUTHOR]

Abstract Cough is a common and commonly ignored symptom of lung disease. Cough is often perceived as difficult to quantify, frequently self-limiting, and non-specific. However, cough has a central role in the clinical detection of many lung diseases including tuberculosis (TB), which remains the leading infectious disease killer worldwide. TB screening currently relies on self-reported cough which fails to meet the World Health Organization (WHO) accuracy targets for a TB triage test. Artificial intelligence (AI) models based on cough sound have been developed for several respiratory conditions, with limited work being done in TB. To support the development of an accurate, point-of-care cough-based triage tool for TB, we have compiled a large multi-country database of cough sounds from individuals being evaluated for TB. The dataset includes more than 700,000 cough sounds from 2,143 individuals with detailed demographic, clinical and microbiologic diagnostic information. We aim to empower researchers in the development of cough sound analysis models to improve TB diagnosis, where innovative approaches are critically needed to end this long-standing pandemic.

BackgroundLow back pain (LBP) presents with diverse manifestations, necessitating personalized treatment approaches that recognize various phenotypes within the same diagnosis, which could be achieved through precision medicine. Although prediction strategies have been explored, including those employing artificial intelligence (AI), they still lack scalability and real-time capabilities. Digital care programs (DCPs) facilitate seamless data collection through the Internet of Things and cloud storage, creating an ideal environment for developing and implementing an AI predictive tool to assist clinicians in dynamically optimizing treatment. ObjectiveThis study aims to develop an AI tool that continuously assists physical therapists in predicting an individual’s potential for achieving clinically significant pain relief by the end of the program. A secondary aim was to identify predictors of pain nonresponse to guide treatment adjustments. MethodsData collected actively (eg, demographic and clinical information) and passively in real-time (eg, range of motion, exercise performance, and socioeconomic data from public data sources) from 6125 patients enrolled in a remote digital musculoskeletal intervention program were stored in the cloud. Two machine learning techniques, recurrent neural networks (RNNs) and light gradient boosting machine (LightGBM), continuously analyzed session updates up to session 7 to predict the likelihood of achieving significant pain relief at the program end. Model performance was assessed using the area under the receiver operating characteristic curve (ROC-AUC), precision-recall curves, specificity, and sensitivity. Model explainability was assessed using SHapley Additive exPlanations values. ResultsAt each session, the model provided a prediction about the potential of being a pain responder, with performance improving over time (P

BackgroundRace/ethnicity and gender concordance between patients and providers is a potential strategy to improve health care interventions. In digital health, where human interactions occur both synchronously and asynchronously, the effect of concordance between patients and providers is unknown. ObjectiveThis study aimed to evaluate the impact of race/ethnicity or gender concordance between patients and physical therapists (PTs) in engagement and the clinical outcomes following a digital care program (DCP) in patients with musculoskeletal (MSK) conditions. MethodsThis secondary analysis of 2 prospective longitudinal studies (originally focused on assessing the acceptance, engagement, and clinical outcomes after a remote DCP) examined the impact of both race/ethnicity concordance and gender concordance between patients and PTs on outcomes for a digital intervention for MSK conditions. Outcomes included engagement (measured by the completion rate and communication, assessed by text interactions), satisfaction, and clinical outcomes (response rate, ie, percentage of patients achieving at least a minimal clinically important change in pain, measured by the Numerical Pain Rating Scale [NPRS]; anxiety, measured by the Generalized Anxiety Disorder 7-item scale [GAD-7]; depression, measured by the Patient Health Questionnaire 9-item [PHQ-9]; and daily activity impairment, measured by the Work Productivity and Activity Impairment [WPAI] questionnaire). ResultsOf 71,201 patients, 63.9% (n=45,507) were matched with their PT in terms of race/ethnicity, while 61.2% (n=43,560) were matched for gender. Concordant dyads showed a higher completion rate among White (adjusted odds ratio [aOR] 1.11, 95% CI 1.05-1.19, P8.52, 95% CI 8.27-8.77) reported across all dyads. Response rates for pain, anxiety, and daily activity impairment were unaffected by race/ethnicity concordance. An exception was observed for depression, with White patients reporting a higher response rate when matched with PTs from other races/ethnicities (aOR 1.20, 95% CI 1.02-1.39, P=.02). In terms of gender, men had a slightly higher pain response rate in discordant dyads (aOR 1.08, 95% CI 1.01-1.15, P=.03) and a higher depression response rate in concordant dyads (aOR 1.23, 95% CI 1.05-1.47, P=.01). ConclusionsRace/ethnicity and gender concordance between patients and PTs does not translate into higher satisfaction or improvement for most clinical outcomes, aside from a positive effect on treatment completion. These results highlight the importance of other PT characteristics, in addition to race/ethnicity or gender concordance, suggesting the potential benefit of experience, languages spoken, and cultural safety training as ways to optimize care. Trial RegistrationClinicalTrials.gov NCT04092946, NCT05417685; https://clinicaltrials.gov/study/NCT05417685, https://clinicaltrials.gov/study/NCT04092946

Aim and background: Acute otitis media (AOM) and otitis media with effusion (OME) are common childhood ear infections. The changing epidemiological landscape in India and growing concerns about antimicrobial resistance underscore the need for evidence-based, updated guidance on management. This expert consensus using the Delphi methodology was undertaken to deliberate and consolidate statements to guide the management of AOM and OME in India. Methods: A panel of 12 experts comprising pediatric infectious disease specialists, clinical microbiologists, and ear, nose, and throat (ENT) specialists participated in a three-step modified Delphi study conducted between April 2023 and January 2024. Overall, 101 statements were derived from an extensive literature search and shared with the experts for their response in the form of “yes” or “no” during round 1. Statements lacking consensus (predefined as

Aim: The present study aimed to evaluate the knowledge, attitude, and practice (KAP) of endodontists in India for working length measurements using Apex locators. Methods: This study is an online questionnaire-based survey consisting of 24 questions in total, divided into five parts. The first part consisted of questions related to demographic details, the second part inquires about the tools and technology used for working length determination, and the remaining questions evaluate the KAP regarding the use of apex locators to determine working length (five questions each). Participants in the study were either pursuing or completed postgraduation in endodontics. A total of 257 responses were recorded; however, six participants were excluded due to incomplete submission. Thus, 251 responses were analyzed as descriptive analyses. Correlation analysis and Chi-square tests were performed to find any association between demographic variables and years of experience in practice with KAP of using apex locators by endodontists. Results: In this study, it was observed that the knowledge of the majority of endodontic practitioners was fair, with a positive attitude and practice of using apex locators. Knowledge of the study participants was significantly (P ≤ 0.05) associated with the good attitude and practice of the study participants. Furthermore, years of experience in practice have a positive association with the KAP of endodontists. Conclusion: It can be concluded that endodontists have better clinical acceptance, as they show positive attitudes and practices for using apex locators for working length determination.