Student's Journal of Health Research Africa

INFORMED CONSENT IN TEENAGE PREGNANCY: DOCTORS’ KNOWLEDGE, ATTITUDES AND PRACTICES AMONGST ANAESTHESIOLOGISTS AND OBSTETRICIANS IN SEVEN KWAZULU-NATAL HOSPITALS.

maseoke mapodile — 2024-10-31

Background

Teenage pregnancy is a global phenomenon. Informed consent practice regarding the sexual and reproductive rights of teenagers may be hampered by physicians’ lack of knowledge or attitude. The study aimed to assess the knowledge, attitudes, and practices of doctors in the process of obtaining informed consent from pregnant teenage patients in seven government-funded hospitals in KwaZulu-Natal.

Methods

A prospective, descriptive, observational study using a self-administered questionnaire was conducted amongst doctors working in Anaesthesia and Obstetrics and Gynecology, from 15 October 2021 to 30 November 2021.

Results

A total of 169 doctors participated in the study, 62.7% from anesthesia and 37.3% from Obstetrics and Gynaecology. Most doctors lacked knowledge regarding the Children's Act No. 38 of 2005 and the Choice on Termination of Pregnancy Act No. 92 of 1996. Approximately 18% of doctors reported obtaining consent for any medical intervention in teenage pregnant patients solely from their parent(s) or guardian, irrespective of the patient’s mental or legal capacity. A fifth (19.5%) of doctors reported that interns were responsible for obtaining informed consent without supervision. Most doctors disclose legally required information in the language the pregnant teenage patient understands, with the assistance of a translator if required. Some doctors revealed paternalistic views regarding teen pregnant patients’ right to choose medical intervention available.

Conclusion

The study found that although doctors met the general legal requirements for informed consent, in most cases, they lacked core knowledge of the relevant acts and laws for sexually active teenagers, thus affecting the validity of the informed consent process.

Recommendation

This could be improved by focusing on filling this knowledge gap at both an undergraduate and postgraduate level as well as a review of the laws/acts that pertain to this population group.

Optimizing Laparoscopic Surgery Outcomes: An Analysis of Risks and Complications in Resource-Constrained Environment

Piyush Tarwey — 2024-12-31

Background: Laparoscopic surgery has enormous advantages over open surgery, the most important of which include decreased postoperative pain, shorter hospital stays, smaller incisions, and quicker recovery. Although laparoscopic surgery has been adopted widely, it continues to present challenges in resource-constrained conditions; that is, the limitation of available records related to surgery according to differing levels of expertise of surgeons sometimes causes great problems in outcome evaluation. This study was conducted to evaluate the incidence, nature, and risk factors for complications during laparoscopic surgery, particularly in a resource-constrained environment.

Methods: This prospective observational study was conducted on 97 patients with different complaints undergoing elective laparoscopic cholecystectomy, appendicectomy, or herniorrhaphy. Patients' demographics, comorbidities, and perioperative variables were collected and analyzed. Statistical analysis was done using the Chi-square test and logistic regression modelling for detecting significant associations, with a p-value of < 0.05 being statistically significant.

Results: The overall complication rate was found to be 17.52%: Cholecystectomy, being the most common procedure (58.78%), had a 15.78% complication rate, whereas appendicectomy had the minimum incidence (3.33%) and herniorrhaphy, the maximum (60%). Risk factors found to be notable correspond with advanced age, hypertension, diabetes, and lesser experience (<4 years) by the surgeons. These risk factors tend to exhibit a strong positive correlation with high complication rates, particularly in cases of herniorrhaphy.

Conclusion: The findings highlight the need for specifically targeted preoperative risk assessments, improved surgical education, and adherence to standardized procedures to reduce complications. Optimization of care strategies and resource allocation by enhancing relative outcomes for laparoscopic surgery can lead to future clinical and research gains in the resource-constrained environment.

Beyond Delivery: A Multifaceted Assessment of Postnatal Care Practices in Central India

shefali jain — 2024-12-31

Context/Background:

The postnatal period is critical for maternal and newborn health, with an increased risk of complications in regions with low access to proper care. Best practices include multiple check-ups within the first six weeks and promoting breastfeeding. Aims/Objectives: . This study evaluated postnatal care quality, accessibility, and effectiveness in Central India.

Methodology:

A descriptive study surveyed 400 mothers who recently delivered in Central India (March 2020-October 2021). Participants came from various healthcare facilities and Anganwadi centres. Representative sampling and informed consent were ensured.

Results:

Despite young mothers (95.5%, 20-30 years) and high institutional delivery rates (nearly 98%), a concerning underutilization of postnatal care was found (only 62.5% received at least one visit). Key barriers included lack of awareness (24.5%), cost/transportation issues (16.75%), and provider availability (8%). While provided care focused on maternal health checks and promoting breastfeeding (76% encouraged exclusive breastfeeding), high vaccination rates (BCG 96.3%, Hep B 1st dose 83.3%) were positive indicators.

Conclusions:

This study highlights the significant underutilization of postnatal care in Central India. Limited awareness and accessibility issues were major barriers. Targeted interventions such as public awareness campaigns and improved accessibility strategies are crucial to improve the region's maternal and newborn health outcomes.

Uptake of Cervical Cancer Screening Services and Associated Factors among HIV Positive Women in Central Uganda: A cross-sectional study.

Edna Mirembe Namuyiga — 2024-12-30

Background

The main objective of the study was to identify the factors associated with the uptake of cervical cancer screening services among HIV-positive women at Mukono General Hospital, a high-volume facility in Central Uganda.

Methods

A cross-sectional study design was used, and quantitative data was collected from 417 HIV patients attending Mukono General Hospital. Systematic random sampling was used, and data was collected using interviewer-administered questionnaires. Modified Poisson regression analysis was used to identify the significance associated with the uptake of CCS at 95% confidence.

Results

The average age of study respondents was 34.4 years with the majority 63.5% (265/417) married and 86.4% (360/417) having a non-detectable viral load. Slightly more than a third 38.6% (161/417) reported having carried out CCS, of which 76.4% (123/161) did it within the last 3 years. Predictors associated with CCS included being of Basoga tribe [APR=1.27, CI=1.07-1.51, P=0.007], Perceiving that CC is curable [APR=0.68, CI=0.48-0.96, P=0.031], believing to be at risk of contracting [APR=3.08, CI=1.94-10.09, P=0.045], having a peer diagnosed with CC [APR=1.14, CI=1.08-1.34, P=0.03], perceiving that screening procedure was nasty [APR=0.70, CI=0.58-0.85, P<0.001], learning about CCS from media [APR=0.074, CI=0.54-0.01, P=0.047] and rating health workers as being professional [APR=2.59, CI=1.23-5.46, P=0.01].

Conclusion

There was generally a low uptake of CCS among HIV/AIDS patients. Strategies to increase the uptake of CCS among the study population should hinge on addressing the knowledge gap and negative perceptions among HIV patients.

Recommendation

District health authorities should conduct regular awareness creation campaigns, targeting HIV-positive women on CC preventive measures.

KNOWLEDGE, ATTITUDE AND PRACTICES TOWARDS THE USE OF POST-EXPOSURE PROPHYLAXIS AMONGST BAR ATTENDANTS AGED 18 TO 35 YEARS IN KAJJANSI TOWN COUNCIL. A CROSS-SECTIONAL STUDY.

Jane Frank Nalubega — 2025-01-16

Background.

Post-exposure prophylaxis (PEP) is recommended for HIV-negative persons at high risk of acquiring HIV after occupational or non-occupational HIV exposure. Bar attendants are a risk group for HIV/AIDS due to risky lifestyles such as alcoholism, smoking, rape, and commercial sex. This study aimed at assessing knowledge, Attitude, and Practices towards the use of post-exposure prophylaxis amongst bar attendants aged 18 to 35 years in Kajjansi Town Council.

Methodology.

A descriptive cross-sectional design was used, involving the quantitative method of data collection using a snowball nonprobability sampling technique to select the study sample. All persons, aged 18+ years who attended bars in the town at the time of the study were included. Data was collected on a daily basis for 7 days and this was from bar attendants in Kajjansi Town Council.

Results.

Majority of respondents were males 92(92%), 35[35%] of the participants were aged between 25-31, (40%) of the respondents were single. 78 (78%) of participants reported having heard about PEP, and 13 (16.7%) of participants correctly identified occupational exposure as a reason for using PEP. Regarding the attitude, 60 (76.9%) reported that they believe PEP is safe for use, 54 (69.3%) of the participants believed that PEP can prevent HIV/AIDS. Concerning the practices, 42(53.8%) of the participants reported a history of PEP usage and 21(50.0%) of the participants said they obtained PEP from hospitals.

Conclusion.

Most of the participants had good knowledge about PEP as they very well knew the indications for PEP but had less information about the duration and the exact timing of utilization of PEP.

Recommendation.

Policymakers should consider public sensitization and awareness Campaigns as a cause to implement the HIV/AIDS reduction and prevention strategies.

EXPERIENCE OF THE EARLY SCREENING PROGRAMS FOR GESTATIONAL DIABETES MELLITUS IN UGANDA. A CROSS-SECTIONAL STUDY.

David Serunjogi — 2024-12-30

Background

Gestational diabetes mellitus (GDM), is the most common metabolic disorder of pregnancy. The study aims to assess the experience of the early screening programs for GDM and Myths about GDM screening, in Uganda.

Methodology

A qualitative field analysis study was carried out at the antenatal care department in Wakiso district, Entebbe municipality at Entebbe Regional Referral Hospital. Eight (9) women (04 without GDM, and 5 without GDM), and 06 Health workers were interviewed using open-ended questionnaires.

Results

Most mothers came to antenatal care without expecting that among things they would do, would include early screening for GDM. Most mothers said that they were happy to have been screened for diabetes during pregnancy and know their status. The program helped mothers to continue living a healthy lifestyle including following the recommendations given by the health workers. They reported not knowing that after diagnosis, the high blood sugar levels would eventually return to normal after delivery. Mothers developed a lot of theories and myths on how one can know if they have high blood sugar levels or not during pregnancy. A Mother said, “Because we were told to check our urine every morning to see if it was sweet or sour. And if it was found sweet that would mean you were diabetic and if sour then you were not diabetic.’’

Conclusion

The results from this public health field analysis show that the early screening program had a valuable impact on both the mothers who took part and the healthcare providers who participated in the implementation of the program.

Recommendation

There is a need for public health professionals in Uganda to develop information, education, and communication materials about GDM.

TETANUS IMMUNIZATION STATUS AND KNOWLEDGE AMONG UNIVERSITY FEMALES AND DOCTORS AT WAD-MEDANI, SUDAN: A DESCRIPTIVE CROSS-SECTIONAL STUDY.

Omnia Motassem — 2024-12-09

Background

Tetanus is a bacterial disease with the majority of reported cases being birth-associated due to unhygienic deliveries and lack of routine maternal vaccination, however, it can be prevented by routine vaccination. The current study aimed to determine tetanus vaccination status and knowledge among university females of childbearing age and the doctors who comprise an important category of maternal healthcare service delivery at Wad-Medani City, Sudan, based on the recommended WHO guidelines.

Methods

A descriptive cross-sectional survey was conducted using two types of researcher-administered questionnaires.

Results

The majority of the surveyed females were never (41.6%) or didn’t know (22.4%) whether they were vaccinated or not, while some were incompletely vaccinated (26.4%), and few (9.6%) were completely vaccinated with the 5 doses of tetanus vaccine. The main reason for none or incomplete vaccination among the females was the lack of awareness (77.4%). On the other hand, 31% of the respondent doctors knew the correct target population to achieve maternal tetanus elimination as recommended by the documented guidelines with only 25% who knew the complete set of vaccine doses, while 63% were under the misconception that it should target only pregnant women or patients with wounds. Further analysis showed that females who have given birth to children or had a history of pregnancy were more likely to receive the complete 5 doses of the vaccine, while correct knowledge was found higher among doctors with advanced years of experience.

Conclusion

Tetanus vaccination coverage was relatively poor, and the main reason was the lack of knowledge about the vaccination program and its importance.

Recommendation

Improving public knowledge through media sources along with other guidance at healthcare facilities can play a vital role in imparting immunization. It is also necessary to ensure the availability of the vaccine and its accessibility for all females.

COVID-19 AND HEPATIC DYSFUNCTION- A PROSPECTIVE STUDY ON THE SEVERITY OF THE DISEASE

Santosh Kumar Nayan — 2024-12-31

Background

A patient who died due to respiratory failure suffering from COVID-19 revealed severe liver injuries in the postmortem. This indicated that the virus starts affecting other organs of the body simultaneously with the respiratory system. Around 23% of the patients who suffered due to COVID-19 had liver injuries. This study has been conducted to determine the relationship between liver injuries with COVID-19 and also to determine the severity of COVID-19 when liver injuries are reported.

Method

This was a cross-sectional study conducted prospectively to determine the correlation between liver dysfunction and the severity of COVID-19. The study was carried out for 6 months at IGIMS, Patna in Bihar, India. 150 patients above the age of 18 years suffering from COVID-19 were considered for this study. Liver function tests and tests for inflammatory markers were carried out and the patients were monitored thoroughly during hospitalization and one month later.

Results

95 patients among the 150 had severe COVID and the remaining 55 had moderate COVID-19. The patients who had moderate COVID-19 infection had around 80% survival rate whereas the patients with severe COVID-19 infection had a 30% survival rate. The non-survivors and those with severe COVID-19 had a higher occurrence of liver dysfunction. Also, it was found that liver enzymes had a substantial association with the presence of inflammatory markers.

Conclusion

This study reported higher levels of liver enzymes in the patients infected with COVID-19 indicating its association. Overall liver dysfunction was prominent among the non-survivors and those who had severe COVID-19. Also, a significant relationship was derived between inflammatory markers and the occurrence of liver dysfunction.

Recommendation

Doctors should monitor inflammatory markers and liver function as well to check the prognosis of the disease in elderly individuals suffering from COVID-19.

BARRIERS ASSOCIATED WITH HIV SELF-TESTING AMONG LIRA UNIVERSITY STUDENTS. A CROSS-SECTIONAL STUDY.

Peter Ssemakula — 2024-12-31

Background

HIV continues to be a significant public health concern, particularly among the young population in our communities, determining the barriers associated with HIV self-testing is very crucial for effective HIV prevention. Therefore, this study aimed to determine the barriers associated with HIV self-testing among the students of Lira University.

Methodology

This study employed a descriptive cross-sectional design, stratified simple random sampling was used, where faculties acted as strata, and then systematic sampling was used to obtain the participants from each year of study. Quantitative data was collected using self-administered questionnaires.

Results

According to the findings, 174 respondents participated in this study, 90(51.7%) were males while 84(48.3%) were female. The age category 20-25 had 145(81.6%) respondents while 31-40 had 25(14.4%) respondents, single respondents were 154(88.5%), Year one had 92(52.9%) respondents, and Year Two had 30(17.2%) respondents, Education Faculty had 59(33.9%) respondents, and the Faculty of Management Sciences were 11(6.3%) respondents. The barriers to the use of HIVST services included Lack of Knowledge 113(64.9%), Concerns about the accuracy138 (79.8%), and Lack of counseling and support services 114(65.5%). Participants with less knowledge were less likely to use HIV self-testing services compared to those who had ever heard about HIVST services cOR: 6.438, p<0.001 also those lacking counseling and support services were less likely to have ever used HIVST services compared to those who had ever attended counseling and support services aOR: 13.265 p<0.001.

Conclusion

The study found that the majority of the respondents were year-one single males from the faculty of education, and their less knowledge of self-testing hindered the use of HIVST services.

Recommendation

Education Programs should be carried out to disseminate information and knowledge about barriers to HIVST services among students.

HEALTH FACILITY FACTORS INFLUENCING MALE INVOLVEMENT IN ANTENATAL CARE AMONG CLIENTS ATTENDING ANTENATAL CLINIC AT NEBBI GENERAL HOSPITAL, NEBBI DISTRICT A CROSS-SECTIONAL STUDY.

Teddy Adero — 2024-12-13

Background

Antenatal care (ANC) is crucial for maternal and fetal health, yet male involvement in ANC remains low globally. Despite efforts to encourage male participation, studies indicate low levels of involvement across Africa, including Uganda. This study aims to identify factors influencing male involvement in ANC at Nebbi General Hospital.

Methods

The study employed a cross-sectional quantitative approach using purposive sampling to collect data from pregnant women and their partners attending the antenatal clinic, with a final sample size of 37 participants, and data analysis conducted using SPSS version 20.0

Results and discussions

There was a 100% response rate with 37 participants. The study revealed that distance to the facility, discussion of antenatal care with health workers, and comfort with health workers' gender were key determinants of male involvement.

Conclusion

Various health facility factors significantly influence male participation in antenatal care (ANC), affecting maternal and child health outcomes.

Recommendation

To improve male involvement in ANC, hospitals should provide flexible clinic hours, especially for working men. District health officers should address health facility factors and train health workers to effectively engage with male partners.

Nursing implications

Nurses should educate expectant mothers and their male partners on the importance of male involvement in ANC and its impact on pregnancy outcomes, advocating for flexible clinic hours to accommodate diverse backgrounds.

SPATIAL AND TEMPORAL DISTRIBUTION OF TUBERCULOSIS INFECTION IN PLATEAU STATE, NIGERIA: A DESCRIPTIVE ECOLOGICAL STUDY.

Ibrahim Bakshak KEFAS — 2024-12-01

Background

This study aimed to describe the spatial and temporal patterns of notified TB patients in 2018, 2019, and 2020 in Plateau State.

Methods

The data were obtained from the State Tuberculosis and Leprosy Control Programme Unit, and the population information was obtained from the National Population Commission. The spatial analysis techniques and time series considered the 17 local government areas as the unit of analysis. The global Moran statistic was used to demonstrate a trend towards clustering over the years of study.

Results

7804 TB cases were reported during the three years of the study from 2018 to 2020. The LGAs with high incidences of tuberculosis were Jos North, Jos South, Mangu, and Langtang North. The global Moran statistic demonstrated an increasing trend towards clustering over the years of study. The Local Indicators of Spatial Association (LISA) statistics showed an insignificant relationship between LGAs and their neighbors (z score of -0.035124 and a p-value of 0.886253). Nevertheless, Jos North, Jos South, and Riyom were the LGAs found to have clustered.

Conclusion

A spatial-temporal pattern that revealed the dynamics of disease spread as the tendency of TB patients to cluster and hot spots of space-time disparities provides useful and detailed information to guide policy formulation to address the burden of TB in the state briefly.

Recommendations

Spatial analysis techniques should be integrated into routine epidemiological surveillance to monitor tuberculosis risk factors in Nigeria. Government policies should support mapping high-risk areas for infectious diseases among the general population to understand prevalence better and enable precise public health interventions.

PREVALENCE AND FACTORS ASSOCIATED WITH POOR PHARMACEUTICAL WASTE DISPOSAL PRACTICES AMONG HOUSEHOLDS IN NANSANA MUNICIPALITY, WAKISO DISTRICT, UGANDA: A CROSS-SECTIONAL STUDY.

HERI LEMBA — 2024-12-02

Introduction

The rising demand for pharmaceuticals globally raises concerns about poor disposal of pharmaceutical waste. Pharmaceutical waste lacks clear guidelines for its management, contributing to environmental pollution and high healthcare costs. While some countries implement effective pharmaceutical waste policies, many developing nations including Uganda, face challenges due to insufficient awareness, regulations, and infrastructure. This study determined the prevalence and factors associated with poor pharmaceutical waste disposal practices in Nansana Municipality Wakiso District, Uganda.

Methods

A cross-sectional study was conducted among 399 households in Nansana Municipality. Stratified sampling was conducted across the four divisions of Nansana Municipality, and a random selection of respondents was made. Data was gathered using a structured questionnaire that included demographics, knowledge, attitudes, and pharmaceutical waste disposal practices. Univariate, bivariate, and multivariable modified Poisson regression analyses identified the prevalence and factors associated with poor pharmaceutical waste disposal.

Results

The study revealed that 72.2% of Nansana Municipality households used poor pharmaceutical waste disposal, predominantly using toilets (91%). Several factors were significantly associated with poor pharmaceutical waste disposal practices in Nansana Municipality. Respondents aged ≥ 30 years were 1.33 times more likely to engage in poor disposal compared to those aged 20-25 years (APR = 1.33; 95% CI: 1.15-1.54). Household monthly income above USD 137 was linked to a lower likelihood of poor pharmaceutical waste disposal (APR = 0.76; 95% CI: 0.59-0.98).

Conclusion

The study found a high prevalence of poor pharmaceutical waste disposal in Nansana Municipality, Wakiso District Uganda. Given the influence of age, gender, education, and income on these behaviors, public health strategies must combine educational, economic, and infrastructural measures for effective impact.

Recommendation

Implementing voluntary take-back programs, enforcing producer responsibility for eco-friendly packaging, and raising public awareness of safe pharmaceutical waste disposal are needed.

A HEALTH WORKERS’ PERSPECTIVE ON TB PREVENTIVE THERAPY FOR CONTACTS OF TB PATIENTS: A CROSS-SECTIONAL STUDY FROM SOUTH WESTERN UGANDA

Dan Mugisha — 2024-12-01

Background

Tuberculosis Preventive Therapy is the key, cost-effective Tuberculosis (TB) prevention strategy but its coverage remains sub-optimal, globally. The objective of the study was to establish factors associated with TPT prescription among PBC TB patients.

Methods

A cross-sectional study was conducted. Data was collected using a data abstraction tool and a self-administered, semi-structured questionnaire from the 17 TB diagnostic and treatment health facilities in Bushenyi district, South Western Uganda. Abstract data was analyzed in Excel for descriptive statistics. Factor analysis was done on the data collected using the questionnaire using. R Core Team, 2023 was used for the analysis.

Results

Of the 781 contacts line-listed for contact tracing, only 442 (77.1%) were prescribed TPT, which is below the 90% target. Factor analysis revealed six factors affecting TPT prescription and these are Latent TB testing, TPT service delivery, TPT financing, human resources for TPT, Monitoring, and evaluation for TPT, and health workers' attitude towards TPT. In the bivariate logistic regression analysis, perception of patient as being uncomfortable with TPT (OR 4.42 95% CI:1.87-11.7; p=0.001), low healthcare worker’s knowledge of TB and TPT (OR 3.94 95% CI: 1.61-11.1; p=0.005), and negative healthcare worker’s attitude towards TPT prescription (OR 4.56 95% CI: 1.28-29.2; p = 0.045) were significantly associated with low TB prescription. In multivariate logistic regression, the perception of the patient is uncomfortable with TPT (aOR 5.58 95% CI: 2.18-16.0; p = <0.001). Gaps in knowledge among healthcare workers about TB and TPT (aOR 5.97 95% CI: 2.08-19.6; p=0.002) were significantly associated with less likelihood of TPT prescription by a healthcare worker.

Conclusions

Whereas TPT is an efficient intervention for the prevention of TB, health system factors remain impediments to its implementation.

Recommendation

Studies be conducted to evaluate the impact of TPT on reducing TB incidence among contacts of PBC TB patients.

A Cross-sectional Study: Prevalence of Depression Among Diabetic Patients

Kamran Fazal — 2024-12-31

Background: Type 2 diabetes mellitus (T2DM) is a growing global health concern, with a significant prevalence in India. Depression is commonly observed in individuals with T2DM, negatively impacting disease management and outcomes. The coexistence of these conditions exacerbates complications and patient well-being.

Aims: This study seeks to assess the prevalence of depression in patients with T2DM and explore its impact on disease progression and management.

Methods: A cross-sectional study was conducted at Jawaharlal Nehru Medical College & Hospital, Bhagalpur, Bihar on 480 T2DM patients attending outpatient and inpatient services. Depression was assessed using the Beck Depression Inventory-II (BDI-II), and various disease-related variables were evaluated. Data was collected through interviews, clinical evaluations, and laboratory tests to assess glycemic control and medication adherence.

Results: The study included 480 diabetic patients, with 85% over 40 years of age, and 61.9% male. Moderate depression was observed in 31.3% (n=150) of patients, while 35% (n=168) had no depression. Depression severity was significantly associated with factors such as age, marital status, family history of diabetes, BMI, fasting blood sugar levels, and duration of diabetes (p<0.001). A high prevalence of depression was noted in patients with a BMI >30 (63.9%), fasting blood sugar >125 mg/dl (72.7%), and those with diabetes for over 5 years (54.7%).

Conclusion: The study emphasizes the strong link between depression and factors like age, BMI, diabetes duration, and blood sugar levels, highlighting the need for integrated mental health care in diabetes management.

DYSLIPIDEMIA IN ELDERLY PATIENTS WITH CEREBROVASCULAR ACCIDENTS: A CROSS-SECTIONAL STUDY.

Rachita Sinha — 2024-12-01

Background

Dyslipidemia is a significant risk factor for cerebrovascular accidents (CVA), especially among the elderly, due to age-related metabolic changes. This demographic is more vulnerable to lipid abnormalities, which increase the risk and severity of ischemic strokes. Despite established guidelines, dyslipidemia remains poorly controlled in elderly populations, underlining the need for targeted lipid management. This study aimed to examine the prevalence of dyslipidemia in elderly CVA patients.

Methods

A study was conducted at MGM Institute of Health Sciences, Navi Mumbai, over 1.5 years, involving 150 elderly CVA patients. Participants underwent lipid profile assessments, and data were collected on demographic, clinical, and lifestyle factors. Statistical analyses were performed using SPSS version 22.0, with chi-square tests and logistic regression applied to determine associations between dyslipidemia and risk factors.

Results

Of the 150 participants, 74.7% had dyslipidemia, with high LDL levels in 60% and low HDL levels in 70.7% of cases. Dyslipidemia was significantly associated with hypertension (OR 2.58, p < 0.01) and diabetes (OR 1.98, p = 0.02). Patients with severe CVA had significantly higher LDL and total cholesterol levels than those with milder CVA presentations (p < 0.05).

Conclusion

The study reveals a high prevalence of dyslipidemia in elderly CVA patients, particularly among those with hypertension and diabetes. Dyslipidemia is associated with increased CVA severity, suggesting that lipid abnormalities may exacerbate stroke outcomes in elderly individuals.

Recommendations

Regular lipid screenings and targeted lipid management should be prioritized in elderly patients with CVA, especially those with hypertension and diabetes. Implementing effective lipid management strategies may reduce morbidity and improve outcomes in this high-risk population.

TYPES OF WASTE GENERATED IN NABARI PAYAM SOUTH SUDAN. A CROSS-SECTIONAL STUDY

Agaar Chep Aboor — 2024-12-01

Background

There is a dire need to create environmental education and awareness, practices, and knowledge in high schools to enhance environmental monitoring and management in the country for both present and future periods. The study aims to assess the types of waste generated in Nabari Payam, South Sudan.

Methodology

A cross-sectional survey, descriptive and explanatory design where quantitative and qualitative methods were adopted. A questionnaire and Focus group discussion were adopted and interviews for Key Informants. Data was analyzed descriptively using the Statistical Package for Social Sciences and thematic methods for quantitative and qualitative data.

Results

197 (59.0%) were male and 137 (41.0%) were female. (47.9%) mentioned inorganic waste, 10 (3.0%) with recyclable waste, 53(15.9%) with solid waste, 100 (29.9%) organic waste, 4 (l .2%) for liquid waste and 4 (1.2%) of the respondents mentioned hazardous waste. Qualitative information also revealed that waste of different types was mixed since there were not enough storage facilities, and in some health centers, nothing was available to store waste generated. One participant said, “….. Here wastes are mixed despite the source and this is due to limited containers. Wastes are discarded together in open space outside the Payam and sometimes I could see the safety boxes are being burnt using kerosene”.

Conclusion

Inorganic and organic waste were the main types of waste generated followed by sharp objects and solid waste. The local people and authorities have limited capacity to manage waste generated per day and this affects the health and environmental aspects of the Payam.

Recommendations

Residents of Nabari Payam should reduce the generation of different types of waste most especially those that are more dangerous, especially if not well managed.

An evaluation of elective orthopaedic operating theatre efficiency at a South African tertiary hospital

Hylda Makanisi — 2024-12-30

Background: The demand for elective orthopaedic surgery has increased in South Africa (SA) due to an increasing burden of trauma and financial constraints caused by a poorly performing economy, highlighting the importance of orthopaedic operating theatre (OT) efficiency in this resource-constrained country. This study aimed to assess the efficiency of elective orthopedic OTs at an SA tertiary hospital.

Methods: This was a cross-sectional study of elective orthopedic OT lists over 8 weeks at Chris Hani Baragwanath Academic Hospital (CHBAH), SA. Data assessed during the study included sub-specialty, number of scheduled and completed cases, time OT commenced activities, time OT ceased activities, case time, turnover time, raw theatre utilization, and day-of-surgery cancellations. The data was analyzed with descriptive statistics.

Results: A total of 117 OT lists equating to 342 cases were included from different orthopaedic subspecialities. The total available OT time was 58331 minutes, of which a large majority, 46638 minutes (80%), was used as case time during conventional OT working hours (95.4%). Fifty-three percent of OT lists started early whereas 29.9% started late, 65% of them underran and 30% overran. The overall raw theatre utilization was 83.0% (range: 71.8-88.2%, SD 16.3) with a DOSC (day of surgery cancelation) rate of 19%.

Conclusion: Overall elective orthopaedic OT utilisation was efficient at CHBAH. The challenge posed by canceled surgeries in CHBAH must be addressed as facility-related reasons were cited as the main reason for cancellations, this will further improve the orthopedic OT efficiency in this hospital.

A REVIEW OF THE INTEGRATION OF TRADITIONAL AND MODERN MEDICINE

Ntombizanele Tshali — 2024-12-13

The integration of traditional medicinal plant knowledge with contemporary pharmaceutical research has enormous potential for the development of novel and cutting-edge modern medication. This study explores how indigenous and traditional uses of medicinal plants can informatively enhance drug discovery and development procedures. Traditional knowledge, honed over decades, frequently includes a thorough understanding of plant-based cures and their therapeutic applications. Case studies where traditional medicinal plants have been used to formulate new drugs will be examined. For instance, the discovery of artemisinin from the traditional Chinese medication sweet wormwood has revolutionized the treatment of malaria. The Madagascar periwinkle, which was traditionally used to treat diabetes, is now the source of the pediatric cancer treatments vinblastine and vincristine. Technologies and methods that can be used to accelerate the translation of traditional practices into modern medicine will also be evaluated. These include systems biology techniques, metabolomics, and high-throughput screening to clarify the mechanisms of action of traditional treatments. Through the documentation of the safety, efficacy, and chemical composition of traditional remedies, researchers can confirm their effectiveness and possibly identify active ingredients for additional research. This approach makes use of indigenous knowledge of traditional medicine to treat modern health issues while also acknowledging the cultural and historical relevance of the practice. Additionally, opportunities and challenges in this multidisciplinary collaboration will be identified.

EFFECT OF AUTHORITATIVE PARENTING STYLES ON ACADEMIC PERFORMANCE IN THE SCIENCES AMONG HIGH SCHOOL STUDENTS IN KABALE DISTRICT. A CROSS-SECTIONAL STUDY.

Murari Maurice Alex Muhwezi — 2024-12-30

Background

Authoritative parenting, as a parenting style, has garnered significant attention and study in the field of psychology, particularly about its impact on self-esteem and academic performance. The study aims to assess the effect of authoritative parenting styles on academic performance in the sciences among high school students in the Kabale district.

Methodology

A cross-sectional design in which a sample of 201 respondents was that consisted of both male and female students from the selected secondary schools. A simple random sampling technique was employed in both the selection of schools and participants. The study applied Pearson product-moment correlation to examine the relationship among the variables.

Results

The prevalence of authoritative parenting style among the respondents, with a grand mean of 3.99 indicates that a majority of participants agreed that their parents practice. A significant number of respondents stated agreement (M = 4.29, SD = 1.03) that their parents are responsive to their feelings and needs. Respondents' agreement (M = 4.30, SD = 0.97) that their parents explain their feelings about their good or bad behavior reflects open communication. The respondents' agreement (M = 4.02, SD = 1.18) that parents explain expectations (M = 3.97, SD = 1.16). Findings highlight that parents' consideration of children's preferences in family plans (M = 3.72, SD = 1.24) and treating them as equal family members (M = 4.53, SD = 0.81) reinforce authoritative parenting's focus on respect for individuality and fostering a sense of belonging. There was no statistically significant relationship between authoritative parenting style and academic performance in sciences, given r (199) = -.002, ρ = .490.

Conclusion

There was no statistically significant relationship between authoritative parenting style and academic performance in the sciences.

Recommendations

Parents should strive to adopt a balanced parenting style that blends authority with open communication.

A CASE REPORT OF A SUBMUCOSAL FIBROID COMPLICATED BY VAGINAL PROLAPSE AND IMPACTION IN A LOW-RESOURCE SETTING.

Innocent Bwire — 2024-12-30

Background

The most common female pelvic tumors that originate from the smooth muscle of the myometrium are called leiomyoma. Although leiomyomas are benign when they are Submucosal, they have the potential to prolapse into the vagina. The traditional method of treating pedunculated fibroid is vaginal myomectomy, however, it cannot always be carried out securely. The purpose of this case report is to illustrate the surgical difficulties when dealing with a large prolapsed pedunculated submucous fibroid. Customized surgical methods allow safe and efficient access to the prolapsed pedunculated fibroid stalk during hysterectomy.

Case presentation

This case involves a 53-year-old perimenopausal female with abnormal uterine bleeding. She had a large prolapsed pedunculated submucous fibroid, with anemia and infection. A modified total abdominal hysterectomy was performed, along with a unilateral sapingo-ophorectomy. The lump was determined by the histopathology report to be a benign leiomyoma without any indication of malignancy.

Conclusions

Regardless of its benignant nature, a large pedunculated submucous leiomyoma presents surgical difficulties during abdominal hysterectomy especially when vaginal prolapse is present and vaginal removal cannot be safely and easily performed. Factors such as parity, fertility desire, hemodynamic stability, prolapsed fibroid size, mobility of fibroid in the vagina, visibility, and size of the stalk need to be evaluated when deciding on the choice of surgical procedures.

Recommendations

The management of a submucosal fibroid with vaginal prolapse should be evaluated carefully and surgical difficulties anticipated when a vaginal myomectomy cannot be done. A prolapsed fibroid size greater than 6cm with the invisibility of the fibroid stalk should warrant consideration of customized approaches, however, no single factor can independently predict the operation of choice and its outcomes.

Hypokalemic paralysis as primary presentation of Sjögren’s syndrome – A clinical case report

Binay Kumar Mahto — 2024-12-31

Sjogren’s syndrome is an autoimmune rheumatic disease characterized by lymphocytic infiltration of exocrine glands resulting in multi system presentations including xerostomia and dry eyes. A 47-year-old woman presented with generalized weakness, difficulty in walking, nausea and pain abdomen. She had reduced muscle power (2/5) with reduced tone, and absent deep tendon reflexes in all four limbs. Further investigation revealed severe hypokalemia with metabolic acidosis. She was treated with intravenous potassium chloride and diagnosed with Sjogren's syndrome based on her serology profile. After treatment, her condition improved. Hypokalemia occurs due to increased renal excretions of potassium. Distal Renal Tubular Acidosis is a major cause of potassium loss in urine. Sjogren's Syndrome is an important cause of Distal Renal Tubular Acidosis, which can present as severe hypokalemia. Although it commonly presents with symptoms like dry eyes and dry mouth, it can rarely present as Distal Renal Tubular Acidosis and hypokalemia as the primary presentation. Sjogren's syndrome should be suspected in patients with hypokalemia with features of Distal Renal Tubular Acidosis.

An assessment of the clinico-radiological and functional results of fixing acetabular fractures with quadrilateral plate involvement using intrapelvic reduction and buttress plate via modified Stoppa technique

Kumar Rahul — 2024-12-31

Background- To achieve the best outcomes, precise reduction in anatomy, fixation of the firm, and rehabilitation are required. The most significant weight-bearing joint in the hip joint, and its fracture is intra-articular is the acetabulum. Several authors have suggested innovative fastening techniques to address these issues, such as an infrapectineal plate and many unique quadrilateral surface buttresses or spring plates to support the quadrilateral plate.

Objectives- The objective of this study was to assess instances of quadrilateral plate acetabular fractures that were treated with internal fixation and open reduction.

Materials and methods- The study was a prospective study which was performed at the Indira Gandhi Institute of Medical Sciences (IGIMS), Patna, Bihar, India. The study has been conducted for one year. Overall, 20 participants were enrolled in the study.

Results- The participants age in this study was 39.2 ± 11.1 years on average. Among all participants, most of the enrolled participants were male. On the right side of 11 (%) hips and the left side of 09 (%) hips, all fractures were unilateral. 05 (%) patients experienced a fall from a height, 07 (%) patients were run over by a pedestrian, and 08 (%) patients were involved in motor vehicle accidents. The surgery took an average of 154 ± 29.1 minutes. According to Matta, the radiographic data showed that the hips in 09 (45%) had excellent results, the hips in 07 (35%), the hips in 03 (15%) had good results, and the hips in 01 (5%) had poor results.

Conclusion- The outcome of the study was that it was a simple, secure, and effective surgical method for pelvic stabilization in carefully selected patients with a quadrilateral plate of acetabulum fractures is shown to be reduced openly and fixed internally. It has a low failure rate and promising results.

Which Should Be Prioritised: Knee Surgery or Spine Surgery? An Examination of Treatment Protocols for Patients with Coexisting Pathologies

Nilesh Kumar Agrawal — 2024-12-31

Background: The increasing prevalence of concurrent degenerative knee and lumbar spine disorders presents a challenge for surgical intervention, as the optimal order of treatment remains unclear. This study aims to investigate the influence of knee deformity on surgeons' preferences for treatment order, contributing to informed decision-making in managing these complex cases.

Methods: This retrospective study was conducted at the Indira Gandhi Institute of Medical Sciences (IGIMS) in Patna over one year, involving 50 patients with low back pain and radiculopathy. Participants underwent comprehensive assessments based on predefined inclusion and exclusion criteria, followed by caudal epidural steroid injections.

Results: Responses were obtained from 25 knee arthroplasty and 25 spine surgeons, achieving response rates of 50% for each specialty. The median clinical experience post-training was 26 years for both groups. Recommendations for "TKA first" varied significantly among knee arthroplasty surgeons, with rates of 32%, 76%, 60%, 8%, and 80% across five scenarios (P < 0.001), while spine surgeons recommended "spine surgery first" at rates of 24%, 80%, 52%, 16%, and 76%, also showing significant differences (P < 0.001). Most spine surgeons indicated their decision would remain unchanged if the procedure was a decompression.

Conclusion: This study emphasizes the significant influence of knee deformity on treatment order preferences among knee arthroplasty and spine surgeons, highlighting the need for individualized decision-making in managing patients with concurrent degenerative knee and lumbar spine disorders.

Association of Total Knee Arthroplasty with Previous Knee Arthroscopy

Anant Akash — 2024-12-31

Background- Before undergoing total knee arthroplasty (TKA), patients with symptomatic degenerative knee changes who are not yet candidates for TKA may undergo a knee arthroscopy (KA). At least 14 million Americans suffer from symptomatic osteoarthritis (OA) of the knee joint, making it a very common condition.

Objectives- The purpose of this study was to determine whether having had a knee arthroscopy in the past was linked to a higher risk of revision following total knee replacement.

Materials and methods- It was a prospective, observational-cohort study which took place at the Indira Gandhi Institute of Medical Sciences (IGIMS), Patna, Bihar, India. The study has been conducted for one year. The study took into account the data from 50 patients in total. Among all patients, 25 patients underwent KA before TKA, while other 25 participants were not undergoing KA before TKA.

Results- The average age of participants in knee arthroscopy group was 55.6±12.9, while average age of participants of no knee arthroscopy group was 61.3±11.8. Most of he enrolled participants were female. Various other co-morbidities were assessed in both the groups including diabetes, hypertension, liver disease, anaemia, alcohol dependency, smoking, depression, obesity and chronic kidney disease. Post-operative stiffness and peri-prosthetic joint infection were found to be statistically significant.

Conclusion- An increased 2-year TKA revision rate is highly correlated with prior KA. Osteoarthritis was the most frequent cause of arthroscopy.

Comparison Between Open Reduction Internal Fixation and Percutaneous Fixation in the Outcome of Scaphoid Fracture

Kumar Rahul — 2024-12-31

Background- Almost 2-7% comprising all the fractures that included scaphoid. Mainly, they were observed in participants of the age group of 20-29 years. It occurs in 10.6 per 100,000 people in a year. Percutaneous screw fixation was possessed to be simpler which helped in the reduction of fracture as well as its fixation and not causing further injuries.

Objectives- The study aimed to compare the ORIF approach to the percutaneous fixation technique for scaphoid fractures to examine the clinical, radiological, and functional results.

Materials and methods- The design of the study was prospective which took place at the Indira Gandhi Institute of Medical Sciences (IGIMS), Patna, Bihar, India. The study has been conducted for one year. Overall, 40 patients were enrolled in the study.

Results- The average age of all the participants was 34.1±8.3. Most of the participating patients were males. The right side of side of fracture was present in 18 (45%) participants, while the left side of the fracture was present in 22 (55%).

Conclusion- The study found that a variety of surgical techniques can be used to treat scaphoid fractures. Two of the most effective methods for treating these fractures are the ORIF technique and percutaneous screw fixation with Herbert screws.

Impact of Prior Anterior Cruciate Ligament Reconstruction on Subsequent Total Knee Arthroplasty

Nilesh Kumar Agrawal — 2024-12-31

Background: Total knee arthroplasty (TKA) in patients with preexisting anterior cruciate ligament (ACL) reconstruction hardware poses unique surgical challenges. The need for hardware removal and complex exposure techniques distinguishes these cases from routine TKA.

Methods: This retrospective matched cohort study included 25 patients undergoing primary total knee arthroplasty (TKA) with prior anterior cruciate ligament (ACL) reconstruction hardware at IGIMS, Patna. Participants were divided into an ACL group and a matched control group without prior ACL reconstruction. Data on demographics, surgical parameters, estimated blood loss, and postoperative complications were collected and analyzed.

Results: The study included 10 patients in the ACL group and 15 in the control group. Operative time was longer in the ACL group (8–16 minutes), though differences in estimated blood loss (EBL) were not statistically significant. Postoperative complication rates were low and comparable between groups. Hardware removal was necessary in 82% of ACL group cases due to modern fixation techniques impeding safe instrumentation.

Conclusion: TKA in patients with prior ACL reconstruction requires meticulous preoperative planning to address extended operative times and surgical exposure challenges while achieving comparable outcomes to routine TKA.

Caudal Epidural Steroid Injection for Low Back Pain and Lumbar Radiculopathy in a Tertiary Care Center

Rajesh Arya — 2024-12-31

Background: Low back pain (LBP) with lumbar radiculopathy is common and affects daily life. Disc herniation and spinal stenosis often cause chronic pain and disability in lumbar radiculopathy. Minimumly invasive caudal epidural steroid injections (CESIs) decrease inflammation and discomfort in affected patients. CESIs may work differently for different spinal diseases. This study aimed to evaluate the efficacy of caudal epidural steroid injections in managing pain and radiculopathy in patients with LBP and lumbar radiculopathy.

Methods: A cross-sectional retrospective case study was conducted on 40 patients treated with CESIs. Inclusion criteria encompassed adults with LBP and radiculopathy, confirmed by MRI findings such as disc herniation, early spondylitis, spinal canal stenosis, and ligamentum flavum thickening. Pain scores were measured using the Numeric Pain Rating Scale (NPRS) at baseline, 1 week, 1 month, and 3 months post-injection. Data were analyzed using paired t-tests and ANOVA to determine statistical significance.

Results: At baseline, the mean pain score was 8.2, which reduced significantly to 4.8 at 1 week, 3.2 at 1 month, and 2.7 at 3 months post-injection (p < 0.001 for each interval). Improvement in radiculopathy symptoms was observed in 75% of patients by the 3-month follow-up. Patients with disc lesions experienced the greatest symptom improvement (78%, p = 0.02), followed by those with ligamentum flavum thickening and spinal canal stenosis. No serious adverse effects were reported.

Conclusion: Caudal epidural steroid injections effectively reduced pain and radiculopathy symptoms in patients with LBP. The greatest benefit was observed in patients with intervertebral disc lesions, suggesting that MRI findings may help optimize patient selection for this treatment. CESIs were safe, with minimal adverse effects.

Recommendations: Further research with larger sample sizes is recommended to explore long-term outcomes and to refine selection criteria based on MRI findings, enhancing treatment efficacy for specific spinal pathologies.

Novel Treatment for Femoral Head Osteonecrosis Using Micro-Core Decompression and Intralesional Zolendronic Acid

Kumar Rahul — 2024-12-31

Background: Avascular necrosis (AVN) of the hip often leads to joint collapse and necessitates total hip arthroplasty, especially in younger patients. Hip preservation strategies, such as core decompression, aim to delay disease progression. Combining micro-core decompression with local zolendronic infiltration is a novel approach with potential advantages.

Methods: This prospective study included 15 patients (19 hips) with AVN stages I to III, treated with micro-core decompression and local zolendronic acid infiltration. Patients were followed for two years, with outcomes assessed using Harris Hip Scores (HHS) and radiological evaluations. Data were analyzed using appropriate statistical tests.

Results: At two years, mean HHS improved significantly across all stages: 97.3 (stage I), 91.1 (stage IIa), 88.4 (stage IIb), and 82.5 (stage III). Radiological improvements included restoration of femoral head morphology and prevention of collapse progression. Postoperative complications were minimal, with two cases of superficial infection and two of trochanteric bursitis, all managed successfully.

Conclusion: Micro-core decompression combined with local zolendronic infiltration effectively improves outcomes in early to intermediate AVN, with minimal complications. This novel technique holds promise for hip preservation, particularly in younger patients.

Evaluation of Caudal Epidural Steroid Injection for Managing Low Back Pain and Lumbar Radiculopathy in a Tertiary Care Center

Anant Akash — 2024-12-31

Background: Epidural steroid injections (ESIs) have been a prevalent therapeutic intervention for managing pain due to lumbar disc injuries since the 1950s, particularly in patients with lumbosacral radiculopathies. This study evaluates the efficacy and safety of caudal ESIs in alleviating pain and improving functional outcomes in affected patients.

Results: Follow-up evaluations showed that 80% of patients reported complete pain relief by the third day, increasing to 92% by the first month, with all patients (100%) pain-free by the third month. The study also indicated the effectiveness of the intervention when complemented with physiotherapy and postural corrections.

Conclusion: Caudal epidural steroid injections are effective and safe for managing low back pain associated with radiculopathy, significantly improving patient outcomes. These findings support the use of this technique as a reliable option for pain management in this patient population.

A RETROSPECTIVE CROSS-SECTIONAL OBSERVATIONAL STUDY INVESTIGATING THE PREVALENT AETIOLOGIES AND CO-MORBIDITIES IN PATIENTS PRESENTING WITH VERTEBRA PLANA IN A SINGLE CENTER SPINE UNIT IN KWAZULU-NATAL, SOUTH AFRICA.

Zovuyo Mgoduka — 2024-12-01

Background

Vertebral plana (VP), characterized by the flattening of vertebrae, presents a diagnostic challenge due to its myriad causes. This study investigated the common histological diagnoses of VP within the unique healthcare context of the King Dinuzulu Hospital Complex (KDHC) Spine Unit in Durban, South Africa, to identify the most common aetiologies in this setting to guide management and prognosis.

Methods

A retrospective observational study was conducted, involving a review of medical records from January 2015 to December 2020. A cohort of 32 patients with VP was analysed for demographics, clinical presentation, imaging findings, and histological diagnoses. The primary objective was to identify prevalent histological causes, enhancing diagnostic precision.

Results

The mean age of participants was 51.1 years, with a slight female predominance. Most patients had low albumin levels and were classified as having complete neurological injury or normal neurological function. HIV status revealed a 34.4% prevalence, influencing histological diversity, while 31.25% had comorbidities, primarily hypertension. The lumbar spine, particularly L2, was frequently affected, correlating with neurologic fallout. Histological analysis revealed a surprising diversity, with multiple myeloma (26.09%) and plasmacytoma (21.74%) emerging as leading diagnoses, challenging prior assumptions. The study found no significant difference in comorbidity prevalence between genders, but a statistically significant discrepancy in the prevalence of diabetes and reduced vertebral density (RVD) between females and males.

Conclusion

This study challenges prevailing assumptions about the aetiology of VP, emphasizing the necessity for a nuanced approach to diagnostic investigations. The unexpected prevalence of multiple myeloma and plasmacytoma suggests a shift in VP aetiology, prompting a re-evaluation of clinical practices.

Recommendation

The study paves the way for further investigation into the pathophysiology and clinical features of vertebra plana. Future research should include multi-institutional diagnosis comparisons and evaluate outcomes based on early versus late or inappropriate management.

A Prospective Study of Eastern Indian Cervical Cancer Screening Practices and Related Factors

Priti Kumari — 2024-12-31

Background- An estimated 120,000 Indian women are affected by uterine cervical cancer each year, which is a serious health issue for them. Although cervical cancer is less common in urban settings, it is still very common in rural areas.

Objectives- this study intends to evaluate the cervical cancer screening behaviors of women in Eastern India and pinpoint the sociodemographic characteristics linked to these practices.

Materials and methods- The design of the study was prospective which took place at the Jawahar Lal Nehru Medical College & Hospital, Bhagalpur, Bihar, India. The study has been conducted for 11 months, i.e., from 24^th January 2019 to 31^st December 2019. Overall, 125 patients were enrolled in the study.

Results- The average age of all the participants was 38.2±7.4. Most of the patients included in the study are from rural areas with 75 (60%), and the rest 50 (40%) are from urban areas. Most of the included patients were from middle-class families and the least were from high-class families. Age among participants who were screened and who were never screened was found to be significant. There was a significant difference observed between socioeconomic status and educational level between the groups of screened and not screened patients respectively.

Conclusion- The study concluded that Eastern India had below-optimal screening rates of cancer of the cervix, especially for women from rural areas, those with lower educational attainment, and those from lower socioeconomic backgrounds.

Eastern Indian Screening Procedures for Cervical Cancer and Associated Factors

Ritika Kedia — 2024-12-31

Background- Gynecological cancer, including cervical cancer, is the second greatest cause of death worldwide for women between the ages of 15 and 44, after heart disease. Among women worldwide, it has been observed that the highest risk of cancer of the cervix has been reported in those living in low- and middle-income countries. Cancer of the cervix is more prevalent in areas where there is a lack of screening and prevention programs.

Objectives- In this study, women in Eastern India who had their cervical cancer screening habits evaluated, and the sociodemographic traits associated with those practices were identified.

Materials and methods- The study was designed as a cross-sectional that took place at the Gouri Devi Institute of Medical Sciences and Hospital, Durgapur, West Bengal, India. The study has been conducted for two years, i.e.,………….. Overall, a total of 100 participants were included to take part in the study. Ethical approval has been granted by the Institutional Ethics Committee (IEC), Gouri Devi Institute of Medical Sciences and Hospital, Durgapur, West Bengal, India under letter number-.

Results- Most of the participants were in the age group of 40 to 50 years. Education level among participants was that 40 participants had a primary level of education; 35 participants had a secondary level of education, and 25 participants had a higher level of education. It has been shown that most of the patients were not screened before.

Conclusion- This study highlights the discrepancy between cervical cancer awareness and screening practices in Eastern India, showing that whereas screening uptake is still insufficient, awareness of cervical cancer is high. Significant obstacles affecting screening participation include cultural beliefs, educational and socioeconomic inequalities, and financial limitations.

The Role of the Fibula in Healing Closed Diaphyseal Tibial Fractures Treated with Intramedullary Interlocking Nailing

Usha Kiran — 2024-12-31

Background: Tibial shaft fractures are common injuries, often managed with reamed intramedullary nailing due to its benefits in providing stability and promoting healing. The study aimed to compare the surgical outcomes of closed tibial shaft fractures managed with reamed intramedullary nailing in patients with either an intact or fractured fibula.

Methods: A total of 130 patients with closed tibial shaft fractures treated with reamed intramedullary nailing were included in this one-year study. Patients were divided into two groups: Group A (intact fibula, n=65) and Group B (fractured fibula, n=65). Outcomes were assessed through clinical and radiographic evaluations at 6, 12, and 24 weeks postoperatively. Functional outcomes were measured using Johner and Wruh’s criteria, and radiological healing was assessed using the RUST score. Statistical analysis was performed to determine significant differences between groups.

Results: The union rate at 6 months was significantly higher in Group B (fractured fibula) at 92.3% compared to 83.1% in Group A (p=0.04). Delayed union was more common in Group A (15.4%) than in Group B (7.7%), with a statistically significant difference (p=0.03). No significant difference was found in malunion or non-union rates between groups. Group B demonstrated better radiological healing with a higher mean RUST score (9.4) compared to Group A (8.6, p=0.01).

Conclusion: Patients with a fractured fibula in conjunction with tibial shaft fractures show a higher union rate and faster healing than those with an intact fibula. The presence of an intact fibula may increase the risk of delayed union.

Recommendations: Clinicians may consider the potential benefits of fibula fracture in enhancing tibial healing when planning treatment strategies. Further research is recommended to explore biomechanical and biological mechanisms underlying these outcomes.

Prevalence and Factors Contributing to Delayed Access to Emergency Obstetric Care Among Mothers in Eastern India

Priti Kumari — 2024-12-31

Background: Maternal mortality represents a significant public health challenge in underdeveloped countries, where numerous women succumb to pregnancy-related complications. Major contributing factors include delays in recognizing medical emergencies and accessing appropriate healthcare services. Analyzing these delays is essential for formulating effective strategies to enhance maternal health outcomes.

Methods: This cross-sectional study was conducted at Jawahar Lal Nehru Medical College & Hospital in Bhagalpur, Bihar, involving 120 women who sought maternity services. Data were collected using a validated questionnaire administered by trained interviewers. Statistical analysis included descriptive and multivariate logistic regression to identify factors associated with delays in seeking obstetric care.

Results: Of the 120 respondents, 86 provided consent and were interviewed, resulting in a response rate of 72%. The average delay in seeking obstetric treatment was approximately 1.5 hours, with 66.7% of participants reporting difficulty in deciding to seek care. Women aged 20-34 and those with lower educational levels experienced significantly higher delays in seeking treatment. Factors such as income, employment status, and antenatal care follow-up also influenced maternal delays.

Conclusion: The study highlights significant delays in seeking obstetric care among women, particularly in younger and less educated populations. Improving awareness and access to maternal healthcare services is essential to reduce these delays.

A Comparative Study Laparoscopic Versus Open Appendicectomy in Adults

Rajani Ranjan — 2024-12-31

Background: A common surgical emergency that typically necessitates an appendicectomy is appendicitis. The decision between laparoscopic and open appendicectomy has generated a lot of discussion, as each procedure has unique benefits and drawbacks. Although laparoscopic surgery is frequently chosen due to its minimally invasive nature, questions still surround its wider applicability, especially in situations of complex appendicitis.

Based on a number of intraoperative and postoperative factors, this study sought to compare laparoscopic versus open appendicectomies.

Materials and Methods: Two groups of fifty patients undergoing interval appendicectomies were randomly assigned. Twenty-five patients in group A had laparoscopic appendicectomies, while twenty-five patients in group B had open appendicectomies.

Results: It was simpler to evaluate the intraoperative findings and confirm the diagnosis in group A patients. Furthermore, patients in group A experienced less discomfort, fewer post operative problems , and a shorter hospital stay.

Conclusion: Laparoscopic appendicectomy is the preferred method for appendicectomy due to its superior results.

Maternal and Perinatal Outcomes in Preterm Premature Rupture of Membranes (PPROM)

Syed Nazaneen — 2024-12-31

Background: One of the main causes of preterm births and a major contributor to neonatal morbidity and death is preterm premature rupture of membranes (PPROM), which is defined as membrane rupture before 37 weeks of gestation without the commencement of labour. In order to inform clinical therapy, this study is to assess the maternal and perinatal outcomes linked to PPROM and to pinpoint important risk factors influencing these outcomes.

Methods: This prospective multicenter study included 80 pregnant women diagnosed with PPROM. The diagnosis was based on clinical history, sterile speculum examination, and confirmation via ultrasound. Participants, grouped by gestational age at PPROM onset (24–36 weeks), underwent either conservative or active management based on gestational age and clinical condition. Maternal and neonatal outcomes were monitored, including infection rates, latency periods, neonatal APGAR scores, NICU admissions, and complications. Statistical analysis assessed associations between management approaches and outcomes.

Results: Of the 80 participants, 60% experienced maternal complications, with chorioamnionitis (35%) and postpartum hemorrhage (12.5%) being most common. Neonatal complications included low APGAR scores in 23.8% of cases, NICU admissions in 62.5%, and a neonatal mortality rate of 7.5%. Conservative management in patients below 34 weeks led to prolonged latency but increased infection rates, while active management in cases above 34 weeks reduced maternal complications. Key predictors of adverse outcomes were gestational age at PPROM onset, maternal age, and presence of infection.

Conclusion: Gestational age and prompt infection control significantly influence PPROM outcomes. Conservative management is beneficial in extending gestational age but necessitates strict monitoring to prevent infections. Induction in cases above 34 weeks effectively minimizes maternal risks without compromising neonatal outcomes.

Recommendations: For cases <34 weeks, conservative management with vigilant infection monitoring is recommended, while for cases >34 weeks, induction may be beneficial.

Evaluating the Role of Diagnostic Laparoscopy in Identifying Tubal and Peritoneal Factors in Female Infertility

Beena Gupta — 2024-12-31

Background: Infertility affects a significant percentage of couples worldwide, with tubal and peritoneal factors being major contributors. While hysterosalpingography (HSG) is commonly used for assessing tubal patency, its limitations in accuracy make diagnostic laparoscopy a preferred choice. Laparoscopy allows direct visualization of the pelvic organs, providing a more accurate diagnosis of tubal blockages and peritoneal pathologies, such as adhesions and endometriosis, which are often undetectable through non-invasive techniques. This study evaluates the effectiveness of diagnostic laparoscopy in identifying tubal and peritoneal factors in female infertility, focusing on its role as a gold standard for infertility diagnosis.

Methods: A cross-sectional study was conducted on 50 women with primary or secondary infertility. Each participant underwent diagnostic laparoscopy following clinical evaluation and HSG. Data were collected on the presence of tubal blockages, peritoneal adhesions, and endometriosis, and results were analyzed to compare findings between primary and secondary infertility groups.

Results: Tubal factors, including bilateral tubal blockage, were identified in 32% of cases, with a similar incidence in both primary and secondary infertility. Peritoneal factors, such as pelvic adhesions and endometriosis, were present in 24% of cases, predominantly in primary infertility. Diagnostic laparoscopy revealed a higher sensitivity for detecting these factors compared to HSG, emphasizing its role in cases where non-invasive imaging was inconclusive.

Conclusion: Diagnostic laparoscopy is a valuable tool for identifying tubal and peritoneal factors in female infertility, offering high diagnostic accuracy and aiding in tailored treatment planning. Its ability to directly visualize pelvic abnormalities makes it essential in the comprehensive evaluation of infertility.

Recommendations: Laparoscopy should be considered in routine infertility workups, especially for patients with unexplained infertility or inconclusive HSG results. Further research on combining laparoscopy with minimally invasive treatments may improve fertility outcomes.

Testicular Mapping And Its Co-Relation With Serum Hormonal Levels

Piyush Agarwal — 2024-12-31

Background: Azoospermia, the complete absence of sperm in the ejaculate, is a major cause of male infertility, affecting 1% of men globally. It is categorized into obstructive azoospermia (OA) and non-obstructive azoospermia (NOA), with NOA being more prevalent and presenting challenges for sperm retrieval. Despite advances in techniques like intracytoplasmic sperm injection (ICSI), reliable markers for successful sperm retrieval in NOA remain unclear.

Aims: This study aims to evaluate histopathological abnormalities in azoospermic males and assess the efficacy of testicular mapping for sperm retrieval. It also focuses on the diagnostic value of serum inhibin B and other hormones in distinguishing OA from NOA.

Methods: The study will involve 25 male patients diagnosed with azoospermia, assessed through a compound testicular mapping procedure with 14 microbiopsies. Hormonal assessments (FSH, LH, testosterone, and inhibin B) will be conducted before and after the biopsy. Histopathological analysis will focus on confirming azoospermia, differentiating OA from NOA, and identifying focal spermatogenesis. Statistical analysis will correlate hormone levels with biopsy findings to evaluate diagnostic outcomes.

Results: The study analyzed 54 cases of azoospermia in men aged 20-39 years, with Nonobstructive Azoospermia (NOA) being more prevalent (74.1%) than Obstructive Azoospermia (OA) (25.9%). NOA cases were further classified into hypospermatogenesis, maturation arrest, and Sertoli cell only syndrome. Hormonal analysis revealed significant differences in serum LH, FSH, testosterone, and inhibin B levels across azoospermia subtypes, with serum inhibin B showing the highest sensitivity and specificity for differentiating OA and NOA. The findings underscore hormonal variability and the potential of inhibin B as a clinical marker for azoospermia classification.

Conclusion: The study highlights significant hormonal differences between obstructive and nonobstructive azoospermia subtypes, with serum Inhibin B emerging as the most reliable marker for differentiation.

COMPARING PROPOFOL AND FENTANYL-MIDAZOLAM COMBINATION FOR CONSCIOUS SEDATION IN FIBREOPTIC NASOTRACHEAL INTUBATION

Shrikanta — 2024-12-31

Background: Awake fibreoptic intubation is crucial for managing difficult airways. The efficacy of propofol compared to a fentanyl-midazolam combination for conscious sedation during this procedure has not been extensively documented.

Methods: This prospective study was conducted over six months at Deen Dayal Upadhyay Hospital, involving 60 patients randomized into two groups. One group received propofol, while the other was administered a fentanyl-midazolam combination. The outcomes measured included the quality of sedation, intubating conditions, hemodynamic changes, degree of amnesia, and global acceptance.

Results: Propofol significantly outperformed the fentanyl-midazolam combination in terms of sedation quality (8.2 vs. 6.7), intubating conditions (85% vs. 70% rated as excellent), and amnesia (90% vs. 60% with no recall). Global acceptance was also higher in the propofol group (9.0 vs. 7.5). Both groups maintained stable hemodynamics throughout the procedures.

Conclusion: Propofol offers superior sedation quality, improved intubating conditions, more profound amnesia, and higher overall acceptance compared to the fentanyl-midazolam combination for conscious sedation in fibreoptic nasotracheal intubation. These attributes suggest propofol as a preferable choice in clinical practice for managing difficult airways.

Comparative Analysis of Propofol and Propofol with Ketamine in Ambulatory Anesthesia Patients

Divyansh Gaur — 2024-12-31

Background- The barbiturate class of sedatives and anesthetics has a prolonged half-life. Ambulatory admittance is used for minor procedures like endoscopies that are performed on outpatients. After the surgery is over, the patients can be released from the anesthetic's effects.

Objectives- The goal of this research was to compare TIVA in ambulatory anesthesia using propofol alone versus propofol plus ketamine.

Materials and methods- The study was designed as a prospective randomized study that took place at the Department of Anesthesia, Deen Dayal Upadhyaya Hospital, Delhi, India. The study has been conducted for six months, i.e., from January 2023 to June 2023. In all, sixty people were invited to participate in the study.

Results- The induction dosage in both the groups of participants were 2.01±0.13 and 1.58±0.4 respectively in the patient groups that received propofol and propofol plus ketamine. Time to recover from induction dose was found to be highly significant.

Conclusion- According to this study, propofol and ketamine together provide better hemodynamic stability when compared to propofol since it requires less induction and has fewer side effects. Additionally, the duration of pain alleviation following surgery was greater.

PERIOPERATIVE OUTCOMES OF SARS-COV-2 POSITIVE PATIENTS WHO UNDERWENT URGENT AND EMERGENCY SURGERY: A RETROSPECTIVE COHORT STUDY AT A SOUTH AFRICAN QUATERNARY HOSPITAL DURING THE SARS-COV-2 PANDEMIC

faheem baba — 2024-12-13

Purpose

This study aimed to assess the perioperative outcomes of SARS-CoV-2-positive patients undergoing urgent and emergency surgeries during the COVID-19 pandemic at a South African quaternary hospital. The primary goal was to determine whether mortality rates and complications in the local setting were consistent with global findings.

Methods

This retrospective review included all SARS-CoV-2-positive patients presenting for surgery from March 1, 2020, to December 28, 2021, at IALCH, Durban, South Africa. Data were extracted from electronic medical records, including demographics (age, sex, American Society of Anesthesiologists (ASA) grading, planned surgery), clinical factors (COVID diagnosis details, degree of respiratory compromise, anesthesia type), and complications.

Results

The major finding from the dataset was the relatively young population of the cohort, with a mean age of 32.5 years among all patients presenting for surgery. Most patients who died were classified as ASA 3 or 4, with multiple comorbidities. Multiple trauma cases were common during the study period, which coincided with a period of strict lockdown.

Conclusion

In this retrospective cohort study of surgical patients with confirmed SARS-CoV-2 infection, 22.8% of patients died. The findings suggest that SARS-CoV-2 may not have had a significant impact on overall all-cause mortality in this cohort. Trauma was a major contributor to mortality, particularly among ASA 3 and 4 patients.

"CLINICAL AND SURGICAL OUTCOMES OF DORSAL SPINE INTRADURAL EXTRAMEDULLARY SPACE-OCCUPYING LESIONS: A PROSPECTIVE INSTITUTIONAL EXPERIENCE"

Dr. Hazi Zawar Sadiq Abbas Dr. Hazi Zawar Sadiq Abbas — 2024-12-09

Background

Space-occupying lesions (SOLs) within the spinal canal can cause compression and distortion of nearby neural tissue. These lesions create space by causing atrophy in the surrounding spinal tissue, leading to neurological deficits. While advancements in neuroimaging techniques have significantly transformed neurologic diagnosis in recent decades, the definitive diagnosis of any central nervous system SOL still requires histological examination of tissue obtained through surgical biopsy.

Aims

To assess the outcome of space-occupying lesions in the spinal region and assess the prevalence of different lesions, including their clinical characteristics based on age, gender, compartmental distribution, and the specific spinal levels affected.

Materials and methods

In this prospective study spanning 1 year at a well-equipped tertiary care hospital in India with a neurosurgery department, 12 specimens (biopsy and surgical) from spinal cord and adjacent structure lesions were examined. The study included indoor patients from the neurosurgery department exhibiting clinical signs, symptoms, and imaging features indicative of spinal space-occupying lesions (SOL). Exclusions comprised primary bone tumors and congenital anomalies, including vascular malformations not involving the cord.

Results

The prevalent age group affected was 41-60 years, with an average age of 47 years, and a higher incidence among females. Neoplastic lesions constituted the majority at 87%, primarily benign or low-grade. Meningioma emerged as the most frequent histologic diagnosis, followed by schwannoma.

Conclusion

Tissue diagnosis is crucial given the diverse range of lesions in the spinal region, each with distinct prognoses and treatment approaches.

Recommendations

Early diagnosis and prompt surgical intervention are essential for managing dorsal spine intradural extramedullary lesions, attention should be given to common diagnoses like meningiomas and schwannomas, to ensure timely and effective treatment.

Comparative Analysis of Propofol and Propofol with Ketamine in Ambulatory Anesthesia Patients

Divyansh Gaur — 2024-12-31

Objectives- The goal of this research was to compare TIVA in ambulatory anesthesia using propofol alone versus propofol plus ketamine.

Materials and methods- The study was designed as a prospective randomized study that took place at the Department of Anesthesia, Deen Dayal Upadhyaya Hospital, Delhi, India. The study has been conducted for six months. In all, sixty people were invited to participate in the study.

A Prospective Randomized Controlled Study on Supraclavicular Brachial Plexus Block: Comparing Dexamethasone and Sodium Bicarbonate as Adjuvants to Local Anesthetics

Shah Raj Jayantilal — 2024-12-31

Background:
Supraclavicular brachial plexus block (SCBPB) is commonly utilized for upper limb surgeries, providing effective regional anesthesia and analgesia. Although local anesthetics are key to successful nerve blocks, the addition of adjuvants can significantly influence the onset, duration, and quality of anesthesia.

Methods:
A prospective randomized controlled study of 100 adult patients (ASA I–II) undergoing upper limb surgeries compared two groups: Group A (SCBPB with local anesthetic + dexamethasone 8 mg) and Group B (SCBPB with local anesthetic + sodium bicarbonate 1 mEq). Onset and duration of sensory and motor blockade, postoperative analgesia duration, and VAS scores were recorded. Data were analyzed using SPSS 23.0, with p<0.05 considered significant.

Results:
Compared to Group B, Group A showed a noticeably longer block duration and a much earlier onset of sensory and motor blockade (p<0.001). Group B experienced sensory block for an average of 8.2 ± 1.9 hours, while Group A had it for an average of 12.5 ± 2.3 hours (p<0.001). Group A's postoperative analgesia lasted 720 ± 150 minutes, which was significantly longer than Group B's (480 ± 130 minutes; p<0.001). At every time interval evaluated, Group A's VAS scores were consistently lower (p<0.001). There were negligible and similar side effects in each group (p>0.05).

Conclusion:
Dexamethasone as an adjuvant to local anesthetics in SCBPB resulted in faster onset, prolonged blockade, enhanced postoperative analgesia, and improved pain control compared to sodium bicarbonate. Both agents showed a similar safety profile.

Recommendations:
Dexamethasone should be considered the preferred adjuvant for improving block characteristics and patient comfort in SCBPB. Further large-scale, multicenter studies could solidify these findings and explore optimal dosing strategies.

Complete laparoscopic hysterectomy utilised the marionette technique in peri-menopausal and post-menopausal females with CIN3

Ved Prakash — 2024-12-31

Background: The incidence of postoperative cervical stenosis and the positive rate of endocervical cone margin rise when cervical conization is performed on individuals with postmenopausal cervical intraepithelial neoplasia 3 (CIN3). This study intends to provide an overview of total laparoscopic hysterectomy as a therapeutic choice for CIN3 patients who are perimenopausal or postmenopausal at a single hospital over a period of 4 years.

Methods: The purpose of this study was to conduct an analysis of medical records from approximately 44-year-old CIN3 patients who underwent open or laparoscopic hysterectomy at our institution between 2017 and 2020 in a retrospective manner. Out of a total of 60 CIN3 patients, 10 were assigned to abdominal total hysterectomy (ATH) group and 50 to total laparoscopic hysterectomy group (TLH).

Results: The laparoscopic hysterectomy group experienced a substantially shorter in-hospital stay (6 days vs. 10 days, p < 0.001) and perioperative blood loss (18 mL vs. 218 mL, p = 0.003) than the abdominal hysterectomy group. Neither the operating length (153.40 ± 26.80 min vs. 160.0 ± 61.40 min, p = 0.825) nor the age at hysterectomy (52 y vs. 76 y, p = 0.053) showed a significant difference between the two groups. 20 patients (or 83.30% of the total) who had diagnostic conization done prior to the procedure had endocervical cone margins that were positive .Two patients who had an abdominal hysterectomy experienced postoperative intestinal obstruction; the other patients showed no significant problems.

Conclusion: For perimenopausal and postmenopausal CIN3 patients, hysterectomy is a suitable therapeutic option, albeit being more intrusive than conization. Due to its less invasive nature, a total laparoscopic hysterectomy with the marionette approach may be the better option in these situations.

A Study on the Haemodynamic Stress Responses to Surgeries and the Intra-Operative and Post-Operative Effects of Dexmedetomidine

Sachin Kumar Gupta — 2024-12-31

Background: The surgical stress response triggers neuroendocrine and hemodynamic variations that can compromise patient outcomes. Dexmedetomidine, an alpha-2 adrenoceptor agonist, offers sedation, analgesia, and hemodynamic stability without respiratory depression.

Methods: This prospective study was carried out at Deen Dayal Upadhyay Hospital over a six-month period and included 60 adult patients (ASA I/II) undergoing elective surgeries lasting over one hour. Patients were randomized into two groups: one receiving dexmedetomidine and the other a saline placebo. Hemodynamic parameters, anesthetic and analgesic requirements, and postoperative pain scores were monitored.

Results: Dexmedetomidine significantly stabilized heart rate, with a reduction from 78.0 ± 4.1 bpm in the placebo group to 69.0 ± 3.5 bpm before induction (p = 0.0001). Mean arterial pressure (MAP) was lower in the dexmedetomidine group after intubation (96.5 ± 2.0 mm Hg vs. 105.4 ± 3.2 mm Hg, p = 0.0001) and during surgery, with values of 84.3 ± 2.2 mm Hg compared to 89.8 ± 2.5 mm Hg (p = 0.0001). Additionally, patients in the dexmedetomidine group required significantly less propofol (93.5 ± 3.1 mg vs. 110.8 ± 7.5 mg, p = 0.0001) and reported lower postoperative pain scores at 60 minutes (0.5 ± 0.3 vs. 1.2 ± 0.4, p = 0.0001).

Conclusion: Dexmedetomidine is effective as an anesthetic adjunct, enhancing hemodynamic stability and postoperative analgesia while reducing anesthetic and opioid requirements

A Cross-Sectional Study of Determinants Influencing Hospital Selection for Patients Undergoing Elective General Surgery

Rajani Ranjan — 2024-12-31

Background: For many patients, the decision to have elective surgery can be extremely difficult. A variety of things may influence their choice of hospital. In order to maximise service delivery and improve patient satisfaction, healthcare providers must have a thorough understanding of these aspects. Finding and analysing the variables influencing hospital preference for patients receiving elective general surgery is the goal of this study.

Materials and Methods: 200 individuals who were scheduled for elective general surgery took part in this study. Demographics, hospital-related characteristics, factors related to surgeon, hospital accreditation, infrastructure and academia were all evaluated using a standardised questionnaire.

Results: The surgeon's competence (93%), attitude towards patients (90%) and cost effectiveness (86%) were the most important variables influencing hospital choice. Additionally, significant were knowing the hospital well (73%) and prior repute of the hospital (76%). Patient choices were affected by the hospital's infrastructure (70%) and accreditation (56%).

Conclusion: The three most important factors influencing hospital choice for elective procedures are cost effectiveness, surgeon skill, and patient experience. Hospital amenities and reputation are also very important. By being aware of these elements, hospital managers can increase patient satisfaction and draw in new patients.

ASSESSMENT OF THE RELATIONSHIP BETWEEN SERUM ALBUMIN AND GLUCOSE LEVELS IN HEALTHY, PRE-DIABETIC, AND DIABETIC INDIVIDUALS’ CASE-CONTROL OBSERVATIONAL STUDY

Kanchan Kumari — 2024-12-17

Introduction

Diabetes mellitus is a metabolic disorder characterized by chronic persistent hyperglycemia. If it persists for a prolonged period, it may lead to microvascular and macrovascular complications. Several studies were done to estimate serum albumin in diabetes mellitus, and there is uncertainty about the relationship between serum albumin and diabetes.

Aim and objectives

The aim of this study is to compare serum albumin in normal, pre-diabetic, and diabetic individuals.

Materials and methods

Glucose estimation was done using the Glucose oxidase Peroxidase method, and Albumin estimation was done using the Bromocresol Green method in Pawapuri, Nalanda.

Results

A total of 160 cases of age between 30-80 years were selected out of which 40 each were healthy, pre-diabetic, diabetic with Glucose levels less than 300mg/dl and above 300mg/dl. The mean Serum albumin level with standard deviation in normal individuals was 4.63± 30, in pre-diabetic individuals was 4.38 ± 0.24, in diabetic individuals were 4.23 ± 0.41, in uncontrolled diabetic individuals were3.98± 0.35. There was a significant decrease in serum albumin in pre-diabetic, diabetic, and uncontrolled diabetic individuals from normal individuals.

Conclusion

There was an inverse relationship between serum Albumin and Glucose in diabetic individuals. By regular estimation of serum albumin in diabetic individuals, the development of complications in diabetic individuals can be delayed.

Recommendation

Regular estimation of serum albumin levels in diabetes and keeping serum albumin levels within normal limits is required to delay diabetic complication development.

MICROBIOLOGICAL SURVEILLANCE OF OPERATION THEATRES OF A TERTIARY CARE HOSPITAL IN BIHAR.

Binay Kumar Mahto KUMAR — 2024-12-31

Background

Microbial contamination of air and environment in operation theatres (OTs) has continued to increase the prevalence of surgical site and hospital-associated infections. Control of these infections in operation theatres is of utmost importance as it can increase patient’s morbidity and mortality.

Aims and Objectives

Aim of the present study was to identify bacterial colonization of surfaces and to determine the microbial contamination of air by estimating the bacterial colony forming unit (CFU) rate in the OT’s of a tertiary care hospital.

Material and Method

This was the tertiary care hospital based retrospective observational study done for a period of 18 months. Data was collected from routine microbiological surveillance of OT’s done between February 2023 to July 2024. Two sampling procedures were considered in this study. For air quality surveillance, settle plate method whereas for surface sampling, soaked swabs from different sites in peptone water were included. Collected samples were transported to Microbiology Laboratory of the institution in sterile condition and careful observation was done of bacterial species, which were isolated and further identified by conventional methods.

Results

A total of 463 samples were collected from different surfaces of various OT’s. Out of these 130 samples showed bacterial growth. The predominant species isolated was Aerobic Spore-Forming Bacilli with 87/130 isolates followed by coagulase-negative Staphylococcus 31/130 , Klebsiella species 8/130 , E.coli 2/130 , Staphylococcus aureus 1/130 & Pseudomonas aeruginosa 1/130.

OT’s air samples showed highest colony forming unit (cfu) rate in Labor room (133cfu/m3) and least cfu rate in Radiotherapy (38cfu/m3).

Conclusions

OTs of our hospital showed highest bacterial contamination in Labor room where the patient load was high and among all the surfaces, OT tables and floor were mostly contaminated with microorganisms.

Prevalence of Nasal Carriage of Methicillin-Resistant Staphylococcus Aureus in a Medical College of Industrial Area of Jharkhand

Roopal Dwivedi — 2024-12-31

Background: Methicillin-resistant Staphylococcus aureus (MRSA) is a significant public health concern due to its ability to cause severe infections and its increasing prevalence in community and healthcare settings. This study aimed to investigate the prevalence of nasal carriage of MRSA in the industrial area of Jharkhand. Understanding the distribution of MRSA carriers is essential for implementing effective infection control measures.

Methods: A cross-sectional study was conducted involving 130 individuals from various healthcare and community settings in Jharkhand. Nasal swabs were collected and analyzed for the presence of MRSA using standard microbiological techniques. Participants identified as MRSA carriers were treated with 2% Mupirocin Nasal Ointment, and training programs on infection control were conducted for housekeeping and security staff.

Results: Out of 130 isolates, 6.15% were found to be carriers of Staphylococcus aureus, with 1.53% being MRSA. Among the carriers, 9.2% were doctors and 66.9% were medical students, indicating a higher prevalence in these groups. The study identified that 76.2% of participants had patient contact, highlighting significant transmission risks. The demographics revealed 42.3% male and 57.7% female carriers, with the majority aged under 25.

Conclusion: The study emphasizes the importance of regular screening and education about MRSA in both healthcare settings and the community. Enhancing awareness and implementing infection control measures are crucial in mitigating the risks associated with MRSA.

HPV Awareness and Vaccination - Are Men and Women equally aware? -A study among college students of Jamshedpur

Avhipsha Kar — 2024-12-31

Background: Human papillomavirus (HPV) is a widespread sexually transmitted infection associated with several cancers. Despite its prevalence, awareness of HPV and its related health implications remains insufficient, particularly among men and younger adults. This study aims to investigate HPV awareness and vaccination coverage among college students in Jamshedpur, with a specific focus on gender disparities.

Methods: Data were collected from 339 college students using a validated questionnaire that assessed knowledge of HPV, vaccination status, and related attitudes. The study analyzed participants' awareness of HPV and its link to cancer, as well as their vaccination history. Statistical analyses were performed to identify significant differences in awareness and vaccination rates between genders and among different academic streams.

Results: The findings revealed moderate awareness of HPV among participants, with 62.8% having heard of the virus and 56.0% recognizing its association with cancer. Women showed significantly higher awareness than men, particularly regarding HPV’s link to cancer (64.0% vs. 46.0%, p = 0.003) and the availability of the HPV vaccine (63.0% vs. 48.7%, p = 0.024). Vaccination rates were low overall, with only 12.4% of participants reporting being vaccinated. A notable gender gap in vaccination rates was observed (16.9% of women vs. 6.7% of men, p = 0.008). Additionally, students from science streams demonstrated better awareness compared to those in arts and commerce, while younger participants (ages 15-25) exhibited greater knowledge of HPV risks.

Conclusion: Despite moderate levels of awareness regarding HPV, significant gaps remain, particularly in vaccine uptake and the inclusion of HPV vaccination in national immunization programs. The findings of this study highlight the urgent need for targeted educational initiatives and vaccination campaigns aimed at bridging these knowledge gaps and improving health outcomes related to HPV.

EVALUATION OF CONCURRENT MALARIA AND DENGUE CO-INFECTIONS AMONG FEBRILE PATIENTS VISITING A TERTIARY CARE HOSPITAL: A CROSS-SECTIONAL OBSERVATIONAL STUDY

Binay Kumar Mahto KUMAR — 2024-12-01

Background

Malaria and dengue are mosquito-borne diseases found in Bihar, West Bengal, Uttar Pradesh, Punjab, Haryana, Delhi, Gujarat, Kerala, Karnataka, and Tamil Nadu. High mortality and morbidity rates make these diseases a major public health issue in these places. The underreporting and misdiagnosis of dengue and malaria concomitant infection is common.

Aim and Objective

To assess the incidence of co-infections with dengue and malaria and to evaluate and compare the severity of these co-infections with that of mono-infections of either disease, based on clinical and laboratory parameters.

Material and Method

A cross-sectional observational study was conducted involving patients who presented with fever and symptoms indicative of malaria and/or dengue. A total of 497 serum samples were collected from these clinically suspected cases. All samples were tested for dengue NS1 antigen and IgM/IgG antibodies using ELISA and immunochromatographic (ICT) tests. Diagnosis of malaria was confirmed via rapid malaria antigen test kits and the identification of Plasmodium spp. through peripheral blood smear microscopy (both thick and thin films).

Results

Among the febrile patients, 155 (31.19%) tested positive for dengue infection, while 342 (68.81%) tested positive for malaria parasites. Notably, 15 (3.02%) cases exhibited co-infections with both dengue and malaria parasites, predominantly Plasmodium falciparum. Haemoglobin <12g/dl 100%, thrombocytopenia, haemorrhagic symptoms (26.67%), renal failure (13.33%), and hepatomegaly (46.67%). 93.33% prevalent in co-infections, more with Plasmodium falciparum.

Conclusion

Co-infections are not uncommon, and failing to identify either condition in cases of concurrent infections can lead to severe complications and potentially disastrous outcomes. Patients from endemic regions must be thoroughly examined, as early diagnosis is critical for effective treatment and can be lifesaving.

Recommendation

It is essential for all febrile patients exhibiting suggestive symptoms to undergo comprehensive testing for both dengue and malaria infections.

FACTORS ASSOCIATED WITH H. PYLORI INFECTION AMONG PATIENTS ATTENDING OUTPATIENT DEPARTMENT AT OUR LADY OF CONSOLATA, KISUBI HOSPITAL. A CROSS-SECTIONAL STUDY.

Catherine Tusingwire — 2024-12-01

Background

Helicobacter pylori (H. pylori) is a Gram-negative spiral bacterium that has long been recognized for its ability to chronically colonize the gastric mucosa and intestine, causing gastritis duodenal ulcers, and gastric carcinoma. This study aimed to assess factors associated with H. pylori infection among patients attending the outpatient department at Our Lady of Consolata, Kisubi Hospital.

Methodology

A descriptive cross-sectional study was employed, and a total of 115 study participants were enrolled using a simple random sampling technique. A semi-structured questionnaire was used to collect information on demographic data, family structure, socio-economic status, level of education, type of drinking water, and hygienic habits of the study participants, stool samples collected from the study participants were tested for the presence of H. pylori using H. pylori antigen test strips.

Results

68(59.1%) of the respondents were married, the most frequent age was that of below 20 years 27.8%, not washing hands 43(55.1%) with OR=2.6(1.12-5.81), p value= 0.0247 was associated with H. pylori infection. H. pylori was exhibited more in married participants at a rate of 51.3%, OR=0.3(0.14-0.81), p=0.0149) and in single people at a rate of 48.7%, OR=2.9(1.24-7.07). Taking unboiled water by the participants increased the chances of them being positive for H. pylori, as this was seen in participants who took unboiled water, these exhibited 64.1%, OR=5.5(2.29-13.42), p=0.0001 and Participants that lived more than 4 people in a household exhibited a high rate of 59.0% OR=0.6(0.26-1.40).

Conclusion

Improper hand washing and drinking of un-boiled water were the most predisposing factors associated with H. pylori infection.

Recommendation

Village health team with local leaders should emphasize hand washing after visiting the latrine and before eating found this will reduce the transmission of H. pylori.

INCIDENCE OF PSYCHOTROPIC DRUGS PRESCRIBED IN CHILDREN AND ADOLESCENTS WITH AUTISM AT EL. TEGANI-ALMAHI REFERENCE HOSPITAL KHARTOUM SUDAN. A CROSS-SECTIONAL STUDY.

Alrazi Eisa Shogar — 2024-12-20

Background:

Autism spectrum disorder (ASD) among vulnerable populations frequently presents with complex mental health diagnoses, and psychotropic medications are often a component of comprehensive biopsychosocial treatment plans for these conditions. The primary aim of this study is to determine the incidence of usage of psychotropic drugs and to assess the response of psychotropic medications prescribed in children and adolescents with autism in a resource-constrained setting in Khartoum Sudan.

Materials and methods:

Following an institutional review board approval, Department of Innovation, Development and Scientific Research, Ministry of Health, Khartoum State (IDSREC-2020-EATA/44/A), A cross-sectional retrospective hospital-based study was conducted from January 2018 to Jan-2021 among 261 children and adolescents aged 1 to 17 years diagnosed with ASD using The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) as a guideline. SPSS version 25.

Results:

The prevalence of ASD was greater in males than females; 45% of autistic patients have at least one comorbid disease. Attention Deficit Hyperactivity Disorder (ADHD), learning disability (LD), and epilepsy are the three most comorbid diseases among autistic patients. The Average number of psychotropic drugs per prescription was 1.8 out of 2.61. The most often prescribed medications among this group were risperidone (49%), methylphenidate (33%), and valproic acid (15%). All the patients received at least one psychotropic prescription; 30% of the patients were receiving polytherapy. Non-adherence of the patient to their medication account for 24%. This indicated the efficacy of other treatment approaches and the importance of combining medication and non-medication therapy.

Conclusion:

The study revealed a significant use of psychotropic medication, with a notable emphasis on antipsychotics. There is a high incidence of prescription rates for psychotropic medications for comorbid psychiatric disorders.

STUDY OF THYROID PROFILE IN CHILDREN WITH CHRONIC KIDNEY DISEASE AT TRIBHUVAN UNIVERSITY TEACHING HOSPITAL

Nivedita Mishra — 2024-12-31

Background: The kidney and thyroid are interconnected, with thyroid hormones affecting renal growth and development. Disturbances in thyroid function can worsen pre-existing kidney disorders. Kidney plays a crucial role in thyroid hormone metabolism, degradation, and excretion, leading to hyper or hypothyroidism. The main objective of the study was to find the association between stages of CKD based on glomerular filtration rate (GFR) and thyroid dysfunction in children.

Methods: This prospective observational study was carried out from October 2019 to October 2020 at a Nepalese tertiary care hospital. Children with CKD ages 1–16 were enrolled. Their medical history, clinical observations, and biochemical tests, including thyroid and renal function tests, were documented on a pre-made proforma. Spearman correlation, the Kruskal-Wallis test, the Fisher exact test, and chi-square were used to examine the data.

Results: Glomerulonephritis was the most prevalent cause of CKD among the 36 children with the disease, accounting for 30.5% of cases. 27 (75%) of the children were between the ages of 11 and 16. The majority of children (28, or 77.78%) were in stage 5 of CKD. Most of the cases (61.11%) had normal thyroid function. Of the children, 14 (38.89%) had hypothyroidism. Low T3 syndrome was the most prevalent type of hypothyroidism, occurring in 5 children (13.9%), and subclinical hypothyroidism occurred in 4 children (11.11%). 2 (5.56%) children had low T4 syndrome, which was the most common thyroid function anomaly.Perhaps as a result of the small sample size, thyroid dysfunction did not correlate with age, gender, length of illness, or declining GFR.

Conclusion:

This study found that children with CKD had subclinical hypothyroidism and low T3 syndrome. Therefore, in order to diagnose and treat thyroid dysfunction early on, a thyroid function test should be conducted on all children with chronic kidney disease.

JOHN LOCKE’S THEORY OF KNOWLEDGE IN RELATION TO THE BATAGWENDA PEOPLE. A CASE OF KICHECHE SUB-COUNTY, KITAGWENDA DISTRICT, UGANDA.

Innocent Ampaire — 2024-12-16

Background

Knowledge is a set of mental and psychological capacities that make mankind a unique, morally different creature. Although all the created may have capacities of reproduction, self-care, and memory, it is only human beings who are self-conscious, rational, and autonomous, can use language, and are responsible for their actions. This study aimed to examine the theory of knowledge according to John Locke about the Batagwenda people of Kicheche Sub-County, Kita Gwenda district, Uganda.

Methods

An explorative case study design with qualitative research approaches was used. Data was collected using a semi-structured interview guide and analyzed thematically to systematically identify, code, and report recurring patterns in a narrative form. It was augmented by a systematic literature review on the life and works of the empiricist philosopher John Locke with a focus on his theory of knowledge.

Results

A total of 30 participants participated in the study. It was affirmed that knowledge is a distinct attribute proper to human beings. It is obtained through sense experience, reasoning, and revelation from God. However, knowledge is limited and all ideas should be subjected to the criteria of truth and certainty.

Conclusion

Knowledge is the highest mental and psychological faculty that defines human beings other factors notwithstanding. It is limited in nature although human beings can obtain knowledge sufficient for their functions. It is obtained in many ways including experience, reasoning, and revelation. It should be subjected to proof based on truth and certainty since it cannot be wholly grasped as it is.

Recommendation

There should be a constant search for knowledge through interactive experiences, reading, and meditation. It requires substantiation based on truth and certainty because it is relative. It should be sought and guarded jealously because it makes human beings unique while fostering a natural tendency toward perfection.

ASSESSING VILLAGE SAVINGS & LOAN ASSOCIATIONS AND HOUSEHOLD WELFARE IN SELECTED VSLA IN KAMULI DISTRICT. A CROSS-SECTIONAL STUDY.

AMBROSE WOLUKAWU — 2024-12-20

Background

For over 100 years, household welfare has remained a major problem affecting a significant portion of the global population. The study aims to assess village savings & loan associations and household welfare in selected VSLA in the Kamuli district.

Methodology

The cross-sectional survey design was implored to collect data. The sample size determination was performed using the Krejcie and Morgan (1970) table. The responses were coded and organized in tables to facilitate their interpretation. To analyze the data, we employed the Statistical Package for Social Sciences version 23.0 (SPSS).

Results

The majority were females at 69% whilst males at 31%. The Pearson correlation coefficient testing the significance between savings and poverty was 0.450 and positive. The p-value for the Pearson coefficient (p = 0.000) is less than 5% significance. The Pearson correlation coefficient testing the significance between loans and household welfare was 0.436 and positive which indicated a moderate positive significance between savings and poverty. The p-value for the Pearson coefficient (p = 0.000) is less than 5% significance. The Pearson correlation coefficient testing the significance between entrepreneurship and poverty was 0.484 and positive. The p-value for the Pearson coefficient (p = 0.000) is less than 5% significance.

Conclusion

Respondents expressed skepticism regarding the capacity of savings to enhance financial security, stability, and independence a divergence from conventional wisdom. There was Skepticism about the efficacy of loans in various aspects of life and a divergence of perspectives among survey participants and key informants regarding various facets of entrepreneurship in the community. Recommendation

VSLAs should reconsider the punitive fines imposed on members who fail to repay their loans promptly.

EFFICACY AND SAFETY OF RETROGRADE INTRARENAL SURGERY (RIRS) FOR RENAL STONE CLEARANCE: A PROSPECTIVE INTERVENTIONAL STUDY.

Nikhil Ranjan — 2024-12-20

Background

The management of kidney stones has advanced with the development of minimally invasive techniques like Retrograde Intrarenal Surgery (RIRS). RIRS, which employs flexible ureterorenoscopy and laser lithotripsy, is a highly promising and safe method for the removal of stones, even in complicated cases. Recent technological improvements have expanded its use, particularly for larger stones (> 2 cm), which were previously treated through percutaneous nephrolithotomy.

Aims

This study seeks to assess the safety and efficacy of RIRS for renal stone clearance in adults. Key objectives include evaluating the success rate of stone removal and analyzing perioperative factors such as surgical duration, complications, and recovery.

Methods

Conducted at IGIMS, Patna, this interventional investigation was performed on 20 adult patients with kidney stones over one year. The surgery utilized a Holmium laser for stone fragmentation, with post-procedural evaluation through X-ray imaging. Data on stone clearance rates, procedure time, complications, and recovery were collated to examine the procedure’s safety as well as effectiveness.

Results

The study included 20 patients with a greater proportion of males and a mean age of 33.4 ± 10.6 years. The stones were mainly located in the middle calyx (40%) and lower calyx (20%), with an average size of 1.06 ± 0.36 cm. RIRS achieved a 100% stone-free rate, with an average surgical duration of 90 ± 18.7 minutes and an average duration of hospitalization (approx. 4.6 days). Complications were minimal, with 90% classified as Grade I and 10% as Grade II. A second RIRS session was required in 10% of cases, and 20% of patients needed a postoperative blood transfusion.

Conclusion

RIRS proved to be a promising treatment for renal stones, demonstrating high stone clearance rates with minimal complications. This technique offers a dependable alternative to traditional treatments, providing shorter hospital stays and manageable recovery outcomes.

THE GREAT PRETENDER: URETHRAL LEIOMYOMA POSING A DIAGNOSTIC CONUNDRUM - A CASE REPORT

Divyanshu Joshi — 2024-12-20

Background

Acute urinary retention (AUR) is a common urological emergency, but it is relatively rare in females. The management of female AUR varies due to the diversity of potential underlying causes, often leading to a lack of consensus in treatment protocols. This case highlights a rare cause of AUR in a female patient, presenting a unique diagnostic challenge.

Case presentation

A 35-year-old female presented to an outside outpatient department (OPD) with complaints of sudden urinary retention, abdominal pain, painful menses, and a mass protruding from the urethra. Examination revealed a tender, non-reducible mass of 5 x 3 cm at the 12-3 o’clock position of the urethra, with a per urethral catheter in place. Pelvic MRI indicated a well-defined, nodular lesion with altered signal intensity along the anterior aspect of the urethra, consistent with a benign mesenchymal lesion. The patient underwent surgical excision of the mass under regional anesthesia. Histopathological examination confirmed the diagnosis of urethral leiomyoma.

Conclusion

Urethral leiomyomas are rare, benign tumors that can present with symptoms similar to other urethral pathologies, including AUR. Surgical resection is the definitive treatment, with a low risk of malignant transformation but potential for local recurrence.

Recommendation

This report emphasizes the need for greater awareness and research into female AUR, especially in developing countries, to improve early diagnosis and management.

Unveiling the Role of PHI in Prostate Cancer Diagnosis: Insights from an Indian Population Study

Aman Gupta — 2024-12-31

Introduction- The Prostate Health Index (PHI) is based on various Prostate-specific Antigen (PSA) derivatives and has been approved in Europe, Australia, and the United States. PHI outperforms its components for the prediction of overall and high-grade prostate cancer on biopsy. With this study, we aim to find out the utility of PHI in the Indian scenario and its role in the decision-making for biopsy when PSA seems to be in the indecisive range.

Patients and Methods –A total of seventy-five patients with PSA in the range of 4-20ng/ml were enrolled in the study. For each patient, PSA parameters including total PSA, free PSA, and p2PSA were determined from blood samples. PHI was determined using the formula (Beckman Coulter) PHI= (p2PSA/free PSA) x √ PSA. All the patients underwent Trans-rectal ultrasound (TRUS)-guided prostate biopsy. We compared the diagnostic performances of these PSA derivatives to predict carcinoma prostate.

Results- About 53.33% were found to be of benign etiology and 46.67% were of malignant etiology based on the histopathology report of the prostate biopsy. PHI had the highest Area UnderThe Curve (AUC) value of 0.9686, followed by p2PSA (0.9236). At the cut-off value of 35.7 PHI has a sensitivity of 94.28% and a specificity of 90% to detect high-grade malignancy. Using the cut-off value of PHI=35, 46.67% of the prostate biopsies could be prevented.

Conclusion –PHI outperformed PSA in detecting Prostate cancer (PC). Higher value of PHI was connected to high-grade PC. We strongly feel that PHI should be widely available in India.

A Comparison of the Clinical Characteristics and Endoscopic Findings of Symptomatic Dyspepsia Patients in Rural and Urban Areas

Kaibalya Ranjan Dash — 2024-12-31

Background: Dyspepsia is a common gastrointestinal disorder affecting a substantial portion of the global population, characterized by various symptoms such as epigastric pain and early satiety. Understanding the differences in dyspeptic presentations among diverse populations can inform more effective diagnostic and treatment strategies.

Methods: This retrospective comparative study was conducted at SCB Medical College & Hospital in Cuttack over one year, involving 100 patients diagnosed with dyspepsia. Participants were selected using non-probability consecutive sampling, with inclusion criteria focused on individuals aged 16 to 75 years presenting with relevant gastrointestinal symptoms. Endoscopic evaluations were performed to assess the underlying conditions.

Results: The study revealed that the majority of patients were aged 31-40 years (25%), with a slight female predominance (55%). The rapid urease test indicated a 60% positive rate for Helicobacter pylori infection among participants. Notable endoscopic findings included erosive antral gastritis observed in 30 rural patients and 35 urban patients, highlighting the differences in gastrointestinal conditions between populations.

Conclusion: The findings underscore the need for tailored healthcare interventions based on demographic factors, as urban patients exhibited a higher prevalence of certain dyspeptic symptoms. This study emphasizes the importance of understanding the clinical and endoscopic variations of dyspepsia to enhance patient care.

HYPERURICEMIA IN DIABETIC PATIENTS : AN ADDITIONAL RISK FACTOR FOR MICROVASCULAR COMPLICATIONS – A CROSS SECTIONAL OBSERVATIONAL STUDY

Binay Kumar Mahto — 2024-12-31

Introduction

This study aims to evaluate hyperuricemia as an additional risk factor for the development of microvascular complications in diabetic patients.

Methods

This study involved a total of 200 diabetic patients, divided into two groups: 100 patients with microvascular complications and 100 without these complications, based on their clinical history and examinations. Serum uric acid (SU) levels were measured in both groups and compared.

Results

Among the 100 patients with microvascular complications, 48 had hyperuricemia, while 52 showed serum uric acid levels within the normal range. In contrast, of the 100 patients without microvascular complications, only 26 presented with hyperuricemia, yielding a P value of 0.0013, indicating a highly significant result. Among the 38 patients with retinopathy, 20 had hyperuricemia and 18 had serum uric acid levels within the normal range, with a P value of 0.0019. Within the group of 32 patients with neuropathy,10 had hyperuricemia and 22 had serum uric acid levels in the normal range, leading to a P value of 0.181. Finally, among the 48 patients with nephropathy, 32 had hyperuricemia and 16 had serum uric acid levels within the normal range, with a P value of 0.000013.

Conclusion

Serum Uric acid is elevated in microvascular complication as a whole group when compared to those without microvascular complication group and further hyperuricemia is strongly associated with nephropathy and retinopathy but not neuropathy.

Recommendation

Correcting hyperuricemia in diabetic patients is vital to overcoming microvascular complications and fostering a path toward improved health and vitality.

A Preliminary Study of Cardiovascular Risk Factor Epidemiology in Desk Job Workers: The HDD Study (Hypertensive, Diabetes & Dyslipidaemia)

Rajendra Prasad Jaiswal — 2024-12-31

Background: The urban Indian population has a higher death rate from cardiovascular disease (CVD), a drawback of industrialization and urbanization. A preliminary investigation into the epidemiology of the three main CVD risk factors— Hypertension, Diabetes & Dyslipidaemia (HDD) among desk job workers was the aim of this study.

Materials and Methods: Utilizing medical records from a week-long on-site medical health screening camp, a retrospective analysis was conducted. A statistical analysis was subsequently performed to compare the BMI and specific behavioural-demographic characteristics (age, gender, smoking, and alcohol consumption status) between the groups with and without HDD.

Results: HDD prevalence was 12.9%, 7.4%, and 14.4%, in that order. The presence of hypertension appears to be associated with age, gender, BMI, and alcohol use, whereas the presence of diabetes is associated with age and BMI alone, and the presence of dyslipidaemia is associated with age, gender, and smoking status.

Conclusion: It emphasizes the necessity of a robust public health education program that promotes and instil healthy lifestyle choices, such as consistent exercise and a nutritious, balanced diet, in the populace to help them control their weight and, ultimately, lessen the burden of chronic diseases both domestically and internationally.

Association of Dyslipidaemia and Comorbidities with Risk Factors Among Diabetic Patients: A Retrospective Analysis

Prabhakar Bhushan Mishra — 2024-12-31

Aim: To determine how risk variables are related to dyslipidaemia and comorbidities in patients with type 2 diabetes mellitus (T2DM).

Materials and Methods: An enrolment of 65 T2DM patients was made using the electronic medical record. We looked for the link between the patients' dyslipidaemia and current comorbidities and the available laboratory, clinical, and demographic data. The SPSS-23 software was used for statistical analysis.

Results: Out of the 65 T2DM patients, 19 (29.22%) were male and 46 (70.76%) were female, with a mean age of 60.12±10.49 years, according to the electronic health record. 31 (47.38%) participants had diabetes mellitus for more than ten years, and 44 (68.30%) subjects had poor glycaemic control (HbA1c > 7%). 21 (31.68%) of the participants in our study had hypertension (HTN), 22 (34.45%) had ischemic heart disease (IHD), 9 (13.84%) were obese, 2 (2.45%) had a stroke, and 53(82.76%) had dyslipidaemia. Out of the 54 patients with dyslipidaemia, 41 (62.44%) were receiving treatment for hypolipidemia.

The lipid profile, which includes HDL (high density lipoprotein), LDL (low density lipoprotein), TC (total cholesterol), and TG (triglycerides), showed a highly significant difference (p-value<0.001) when comparing the research variables based on dyslipidaemia against normal lipid levels, but many other variables did not show a significant difference. Subjects with dyslipidaemia had significantly higher HBA1c, FBG, and RBG levels. Our patients' age ranges of 60–69 and 70–79 years had a strong correlation with comorbidities, according to a logistic regression study of risk variables and comorbidities. Likewise, no statistically significant correlation was found between our patients' dyslipidaemia and risk variables when analysed using logistic regression.

Conclusion: Our findings showed that comorbidities were linked to aging and that HTN, IHD, and dyslipidaemia were prevalent comorbidities. The present patterns in T2DM comorbidities and symptomatology have been brought to light by our investigation. All

A Retrospective Cohort Study Statin Lipophilicity and the Risk of Developing Heart Failure

Brajesh Kumar Singh — 2024-12-31

Background: The cornerstone of the battle against cardiovascular disease is statin medication, which lowers cholesterol. In recent research, there has been considerable discussion regarding whether lipophilicity of statin raises the risk of heart failure. Examining the relationship between incident heart failure and statin lipophilicity is the aim of this retrospective cohort investigation.

Methods: For this retrospective cohort study, electronic health records were utilized. Every participant had to be at least eighteen years old and have a history of taking statins. The two types of statins were classified as less lipophilic and highly lipophilic. Heart failure rates were assessed during the study. A statistical model accounting for confounding variables was used to compute hazard ratios and 95% Confidence Interval.

Results: Those on highly lipophilic statins had a slightly greater overall rate of heart failure (3.3 cases per 1,000 person-years) than those taking less lipophilic statins (2.5 cases per 1,000 person-years) in our study of 100 patients. The association between highly lipophilic statins and an increased risk of heart failure was not statistically significant (Hazard Ratio: 1.31, 95% CI: 0.88 - 1.95).

Conclusion: In line with earlier studies, this study highlights the complex relationship between lipophilicity of statin and the heart failure risk. Even though there was no statistically significant trend, the complex nature of the link necessitates more research in bigger, more representative cohorts. Clinicians should consider the unique characteristics of each patient while prescribing statins in the absence of conclusive proof.

AN OBSERVATIONAL STUDY TO ASSESS THE CLINICAL-ETIOLOGICAL PROFILE OF HYPONATREMIA IN PATIENTS PRESENTING TO THE EMERGENCY DEPARTMENT IN A TERTIARY CARE HOSPITAL.

Namrata Mathur — 2024-12-30

Background

When the serum sodium level is less than 135 mmol/l, it is called hyponatremia. It may show a range of symptoms, including nausea, tiredness, seizures, coma, and sometimes even death. If identified immediately, proper treatment can reduce these symptoms and fatality rates. This study assessed the clinical characteristics and underlying causes of hyponatremia in admitted patients.

Materials and Methods

This study was observational. Patients who were at least 14 years old and had serum Na+ levels ≤130 meq/l were included in the study. Patients were diagnosed as having hypovolemic hyponatremia, hypervolemic hyponatremia, or euvolemic hyponatremia based on the results of their medical histories and physical examinations. The syndrome of inappropriate antidiuresis (SIAD) was identified in patients with clinical euvolemia, urine Na+ >20 mmol/l, serum uric acid ≤4 mg/dl, satisfactory renal function (serum creatinine and blood urea), and no pituitary or thyroid disease.

Results

The study comprised 100 individuals with hyponatremia. 56 individuals had severe hyponatremia. 38 patients experienced vomiting, 7 experienced hiccups, 19 hyponatremic patients were asymptomatic, and 43 patients had altered levels of consciousness manifested as sleepiness, disorientation, irrelevant talking, or coma. Euvolemic hyponatremia (71%) was the most common, followed by hypervolemic hyponatremia (27%), and hypovolemic hyponatremia (2%).

Conclusion

Ages 60 to 69 were the most common range for hyponatremia. The majority of patients belonged to the hypervolemic category after the euvolemic group. The most typical signs of hyponatremia were impaired sensorium, vomiting, and, infrequently, seizures.

Recommendation

Diuretics should be used with caution, especially in more vulnerable groups, as they often result in hyponatremia. Diuretic-induced hyponatremia may occur, but additional factors, including the patient's euvolemic status, should be considered to prevent it from always turning hypovolemic. The intensity of the symptoms should be given priority over serum salt levels, as there is no correlation between them.

Characterization of Mortalities requiring Autopsy by a Medical Board

Anand Kumar — 2024-12-31

Background

In general, a single autopsy surgeon undertakes medico-legal autopsies; nonetheless, in particular scenarios, a collaboration of medical experts may occur. This involvement is frequently a consequence of administrative mandates rather than established protocols, highlighting the necessity for unequivocal guidelines.

Methods

A cumulative total of 262 records pertaining to post-mortem examinations performed by Medical Boards from April 2015 to March 2020 were acquired subsequent to the fulfilment of our established criteria through the method of consecutive sampling in this retro-prospective observational study, which was executed within the Department of Forensic Medicine and Toxicology at the Rajendra Institute of Medical Sciences, Ranchi. The data were systematically documented in a case report form, a template was subsequently developed, and later subjected to analysis utilizing appropriate statistical methodologies.

Results

In 17 cases (6.5%), the identification of the deceased individual could not be ascertained. A total of 5.3% (14) of the cases exhibited a considerable degree of decomposition. The majority of the autopsies [19.5% (51)] were conducted on individuals within the 21 to 30 years age demographic, comprising 212 males and 47 females. Nearly half, specifically 46.6% (122), of the autopsies were carried out on individuals identified as adherents of Hinduism, whilst 34.0% (89) were performed on adherents of the Sarna faith. Out of all autopsies, over half, accounting for 55.3% (145), were done on non-tribal people, contrasting with 38.2% (100) that were on tribal people. A significant majority, amounting to 74.0% (194), of the autopsies were conducted on individuals who were married.

Conclusion

The majority of the autopsies were conducted within the younger demographic strata, exhibiting a significant predominance of male subjects, alongside a remarkable scarcity of unidentified and decomposed remains.

Type 1 Diabetes in Transfusion-Dependent Beta-Thalassemia Major a case series

Bikash Chandra Nanda — 2024-12-31

Background: Regular blood transfusions, essential for managing transfusion-dependent beta-thalassemia major (TDT), frequently lead to iron overload, which can harm multiple organs, including the pancreas. Iron deposition in pancreatic beta-cells may result in Type 1 Diabetes Mellitus (T1DM). This case series examines the clinical characteristics, diagnostic findings, and management strategies for ten adult TDT patients who developed T1DM due to iron overload.

Methods: This study included 10 adult patients, aged between 18 and 35 years, presenting with TDT. Data collected encompassed fasting plasma glucose (FPG), HbA1c, serum ferritin levels, and chelation therapy adherence. All patients required chronic transfusion therapy and exhibited varying levels of compliance with iron chelation protocols.

Results: In this case series, ten patients with transfusion-dependent beta-thalassemia major (TDT) exhibited ferritin levels ranging from 2,600 to over 4,000 ng/mL and HbA1c levels between 6.5% and 9.2%, reflecting varying glycemic control. All patients had elevated fasting plasma glucose (FPG) levels, ranging from 110 to 200 mg/dL. Chelation therapy compliance was generally poor or suboptimal, influencing clinical outcomes. While most patients showed improvement or stabilization after treatment, one patient had limited improvement due to advanced disease complications.

Conclusion: Proactive monitoring for glucose abnormalities and rigorous adherence to iron chelation are essential to mitigate diabetes onset in TDT patients. Regular oral glucose tolerance tests (OGTT) and comprehensive care are recommended to address this high-risk population effectively.

Comparative Study of Standard PCNL Versus Mini PCNL for the Treatment of Renal Stone of Size 10-30 Mm

Rakesh Kumar — 2024-12-31

Background- About 2-3 percent of the general population suffers from urolithiasis. When percutaneous nephrolithotomy (PCNL) was introduced, open surgery was no longer the primary surgical treatment for renal stone disorders. There are currently few studies comparing Mini PCNL to regular PCNL. Furthermore, their relative safety and effectiveness are still up for discussion.

Objectives- The goal of the study was to compare the effectiveness of Mini PCNL with regular PCNL in treating kidney stones that were between 10 and 30 mm in size.

Materials and methods- It was a prospective-interventional study. The study took place at the Department of Urology, Indira Gandhi Institute of Medical Sciences (IGIMS), Patna, Bihar, India. The study was conducted for one year, i.e. from November 2021 to December 2022.

Results- With a p-value of 0.0001, the average decline of hemoglobin in mini PCNL was 0.79 ± 0.37 and in Standard PCNL it was 1.34 ± 0.84. Both were deemed significant. The average number of days spent in the hospital after surgery was 4.38 ± 1.079 in Mini PCNL and 5.30 ± 1.47 in Standard PCNL, with a p-value of 0.18. The characteristics that were determined after the treatment were stone-free status, the need for ICU, the need for blood transfusion (BT), and fever post-operatively.

Conclusion- The study concluded that mini PCNL can be considered safe, acceptable, and effective modality and alternative to Standard PCNL for the treatment of renal calculi of sizes 10-30 mm resulting in less post-op complications, lesser post-op hospital stays, lesser bleeding, and lesser chances of post-op fever and post-op ICU admission.

ULTRASONOGRAPHY AND PREGNANCY OUTCOMES IN CASES OF THREATENED ABORTION: A PROSPECTIVE OBSERVATIONAL STUDY

Maryam Quadri — 2024-12-31

Background

Threatened miscarriage, characterized by vaginal bleeding in early pregnancy, is a common complication that can significantly impact maternal and fetal outcomes. The ability to accurately predict pregnancy loss is crucial for effective clinical management. This study aims to evaluate the diagnostic performance of early ultrasound parameters in predicting pregnancy outcomes among women presenting with threatened miscarriage.

Methods

A prospective observational study was conducted involving 200 patients diagnosed with threatened miscarriage at a tertiary care center. Inclusion criteria included normal body mass index (BMI), a known last menstrual period (LMP), absence of cervical pathology, and a single viable pregnancy. Participants were divided into three groups: Group I (pregnancy loss), Group II (ongoing pregnancy), and Group III (control group). Ultrasound examinations were performed to assess fetal heart rate (FHR), gestational sac diameter (GSD), crown-rump length (CRL), and yolk sac diameter (YSD). Maternal and neonatal outcomes were recorded, and statistical analyses were performed using SPSS 10.

Results

Among the participants, 30% experienced pregnancy loss (Group I), while 70% continued their pregnancies (Group II). Significant differences were observed in ultrasound parameters, with Group I showing lower FHR (mean 98.2 bpm) and smaller GSD (mean 14.5 mm) compared to Groups II and III. The diagnostic performance of FHR <100 bpm and GSD <15 mm was found to be highly predictive of miscarriage, with sensitivities of 85% and 80%, respectively.

Conclusion

Early ultrasound parameters, particularly FHR and GSD, are valuable indicators of pregnancy outcomes in cases of threatened miscarriage. Their predictive capabilities can guide clinical management, allowing for closer monitoring and tailored interventions.

Recommendations

It is recommended that clinicians utilize early ultrasound assessments in women presenting with threatened miscarriages to improve pregnancy outcomes. Further studies are needed to validate these findings and explore additional markers that may enhance predictive accuracy.

Concurrent Diabetes Mellitus and Renal Insufficiency as Prognostic Indicators for Acute Myocardial Infarction

Brajesh Kumar Singh — 2024-12-31

Background: Acute myocardial infarction (AMI) is a leading cause of morbidity and mortality worldwide. Two important risk factors that independently impair the prognosis of individuals with AMI are diabetes mellitus (DM) and renal failure. Because of the increased risks they provide, research on the combined impact of these comorbidities on patient outcomes is crucial. This study focused on in-hospital mortality, length of hospital stays, and major adverse cardiac events (MACE) in order to determine the prognostic importance of concurrent diabetes mellitus and kidney failure in individuals with AMI.

Methods: 100 people with AMI participated in this cohort study, which ran from September 2023 to August 2024. Based on whether or not they had diabetes mellitus and renal insufficiency, participants were divided into four groups. To account for potential confounders, multivariate regression analysis, ANOVA, chi-square tests, and descriptive statistics were used to examine clinical outcomes.

Results: The patients in Group IV, who had both kidney failure and diabetes, had the highest incidence of MACE (56.2%) and the longest hospital stay (7.9 ± 3.2 days) and also the highest rate of mortality in hospital (26.8%). Both renal failure (Odds Ratio 3.2, 95% Confidence Interval 2.1-4.9) and diabetes mellitus (Odds Ratio 2.4, 95% Confidence Interval 1.6-3.6) were found to be significant independent predictors of unfavourable outcomes using multivariate regression analysis.

Conclusion: Following an AMI, patients with concurrent diabetes mellitus and kidney failure have far worse outcomes than those with either condition alone or neither. These results highlight the necessity of close observation and specialized treatment plans for this high-risk group.

Recommendations: For AMI patients who also have diabetes and renal failure, healthcare practitioners should use integrated care approaches. To enhance outcomes for these patients, further research should concentrate on creating and assessing targeted therapies.

A Systematic Study and Meta-Analysis of Tuberculosis Infection Prevalence in India

Prabhakar Bhushan Mishra — 2024-12-31

Background and objectives: O The purpose of this systematic review and meta-analysis was to calculate the prevalence of TBI in India by risk categories, sociodemographic profile, and geographic location.

Methods: Through a comprehensive analysis, this study investigated the prevalence of tuberculosis infection (TBI) in India between 2013 and 2022. Following the recommendations in the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA), 70 papers were examined using databases such as Scopus, CINAHL, EMBASE, and MEDLINE. The holistic method provided a detailed picture of the prevalence of TBI in India by using a variety of languages and study settings.

Results:70 research, including approximately 40 prevalence studies and approximately 30 long-term studies, were included in this paper after a review of 10,510 papers. Based on population-based sample studies, the total prevalence of tuberculosis infection (TBI) in India was determined to be 40.79 %. When highly sensitive populations were excluded from the general population, this percentage remained constant at 35.99%. There was a commensurate increase in TBI prevalence in areas with higher active TB burdens, particularly in Tamil Nadu and Delhi.

Conclusion: The current thorough investigation demonstrated the high prevalence of TB infections in India, which corresponded with proactive TB infections and suggested a possible transition from latent to active TB. Notably, people living in the southern regions of the country were more likely to experience this possibility. In order to properly manage TBI in India, it is imperative that these regional variations be addressed in order to prioritize and adapt customized methods.

Recommendation: In order to assist efficient programmatic management in the pursuit of India's TB elimination targets, our study suggests giving priority to Tuberculosis Preventive Treatment (TPT) in areas with high prevalence of Tuberculosis Infection (TBI) and promoting a "No test, treat only" approach for resource efficiency.

Effectiveness of single chest tube vs double chest tube drainage application in patients undergoing decortication: A retrospective study

Sudhanshu Singh — 2024-12-31

Background: Chest tube drainage is essential following decortication for stage III empyema thoracis. While double chest tube placement is widely used, a single chest tube may offer comparable efficacy with reduced postoperative pain. This study evaluates the effectiveness of these two approaches.

Methods: A retrospective comparative study was conducted on 84 patients at Patna Medical College and Hospital from November 2021 to November 2024. Patients were randomly assigned to either single (Group A) or double (Group B) chest tube drainage. Primary outcomes included total drainage volume, duration of drainage, and pain scores, while secondary outcomes were air leaks, chest tube reinsertion, and hospital stay. Data were analyzed using SPSS, with statistical significance set at p<0.05.

Results: Group A had a higher total drainage volume (1200 mL vs. 500 mL) and lower pain scores (2 vs. 3) than Group B. Drainage duration was longer in Group B (5 vs. 4 days), but both groups had similar hospital stays (6-7 days). No reinsertion of chest tubes was required in either group, and lung expansion outcomes were comparable.

Conclusion: Single chest tube drainage is slight more effective than double chest tube drainage after decortication, with comparable outcomes and reduced invasiveness, suggesting its utility in clinical practice.

Evaluation of Hematological Parameters and Their Association with Thyroid Hormone Levels in Women of Reproductive Age

Pawan Trivedi — 2024-12-31

Background: Thyroid hormones, particularly triiodothyronine (T3) and thyroxine (T4), are important for the regulation of metabolism and organ function, with imbalances linked to health issues such as hypothyroidism and hyperthyroidism. This study explores the correlation of thyroid hormone levels with hematological parameters in non-pregnant women aged 40 to 65 years, aiming to enhance clinical management of these conditions.

Methods: A one-year study was conducted at Maharshi Devraha Baba Autonomous State Medical College, including 500 non-pregnant female patients diagnosed with thyroid disorders. Participants were classified into hyperthyroid and hypothyroid groups based on clinical symptoms and laboratory results, with a control cohort of 100 age-matched females having normal thyroid function. Blood samples were analyzed for serum T3, T4, and TSH levels, along with hematological parameters using a hematology analyzer.

Results: The study included 500 non-pregnant females, with 250 diagnosed with hypothyroidism, 250 with hyperthyroidism, and 100 euthyroid controls. Hypothyroid patients had significantly lower T3 (1.2 ± 0.35 nmol/L), T4 (54.40 ± 37.60 nmol/L), and elevated TSH (145.67 ± 192.40 mIU/L). Hematological analyses revealed lower hemoglobin (11.30 ± 1.10 g/dL) and RBC counts (4.02 ± 0.45 x10^6/µL) in hypothyroid subjects compared to euthyroid counterparts. No prominent variations were found in hematological parameters between hyperthyroid and euthyroid groups, although hypothyroid patients showed higher RDW and AEC.

Conclusion: The investigation demonstrates a significant correlation between thyroid dysfunction and hematological abnormalities, especially anemia in hypothyroid patients, emphasizing the need to evaluate thyroid hormone levels in women with unexplained anemia for better management.

STUDY OF MICROALBUMINURIA AS A CARDIOMETABOLIC RISK FACTOR IN TYPE 2 DIABETES MELLITUS: A CROSS-SECTIONAL STUDY.

Sugatha Sahu — 2024-12-20

Background

The rising occurrence of type 2 diabetes mellitus (T2DM) presents considerable health hazards, particularly concerning heart-related complications. The presence of microalbuminuria acts as an important indicator for the early identification of vascular injury and cardiometabolic risks in individuals with T2DM, emphasizing the necessity for regular screening.

Aims

This work aims to assess the prevalence of microalbuminuria in individuals with type 2 diabetes mellitus in patients residing in Odisha.

Methods

This cross-sectional study took place for over 2.5 years at MKCG Medical College and Hospital, involving 110 patients diagnosed with T2DM. Participants were recruited from the outpatient and inpatient departments of General Medicine and Endocrinology, after obtaining informed consent. Comprehensive demographic and clinical data were collected, alongside laboratory assessments for microalbuminuria using an immunoassay method.

Results

The study comprised 65 males and 45 females, with an average age of 57.07 years. Microalbuminuria was found in 24 of 27 patients (88.89%) with diabetes for 11 years or more (p < 0.05). Additionally, 25 of 41 patients (61%) with elevated HbA1C levels had microalbuminuria. Mean fasting blood sugar was significantly higher in the microalbuminuria group (142.83 ± 37.32 mg/dL vs. 127.85 ± 31.36 mg/dL).

Conclusion

Microalbuminuria is significantly associated with the duration of diabetes, poor glycemic control, dyslipidemia, and renal dysfunction in patients with type 2 diabetes mellitus.

Recommendation:

Microalbuminuria is a marker of vascular disease and can be used to support further therapy directed at this complication. For the stated reasons, microalbuminuria testing is recommended.

Evaluation of Intraocular Pressure Outcomes and Failure Risk Factors in the Collaborative Study on Bleb-Related Infection and Treatment

Marianus Deepak Lakra — 2024-12-31

Background:

Trabeculectomy remains the primary surgical intervention for glaucoma management, enhanced by adjunctive therapies like mitomycin C, despite the associated risk of complications such as bleb-related infections. The Collaborative Bleb-Related Infection Incidence and Treatment Study (CBIITS) aims to assess the incidence and risk factors for these infections.

Methods:

This prospective study included 30 patients undergoing filtering surgeries at Rajendra Institute of Medical Sciences (RIMS), Ranchi, with follow-up at six-month intervals over three years. Intraocular pressure (IOP) was measured preoperatively and postoperatively using Goldmann applanation tonometry, and surgical success was defined based on IOP thresholds from the World Glaucoma Association. Statistical analyses included Kaplan-Meier survival analysis and Cox proportional hazards models to evaluate outcomes and associated risk factors.

Results:

The study involved 30 patients with a mean age of 62.8 years and a mean follow-up of 12.3 months. Primary open-angle glaucoma was the most common diagnosis (50%). Multivariate analysis indicated that previous glaucoma surgeries significantly impacted treatment outcomes, with 76.7% of patients having no prior surgeries achieving better results. Postoperative complications were observed in 9 patients (30%), with early complications such as hyphema and choroidal detachment occurring in 6 (20%) and 10 (33.3%) cases, respectively.

Conclusion:

Surgical history and lens status are crucial for the success of trabeculectomy in glaucoma management, emphasizing the importance of monitoring postoperative complications.

RISKS ASSOCIATED WITH MEDICAL GLAUCOMA TREATMENT FOR CATARACT PATIENTS: A PROSPECTIVE OBSERVATIONAL COHORT STUDY

Ratkal Ashwini Mallikarjun — 2024-12-20

Background

Glaucoma and cataracts are common ocular conditions often found together, posing significant challenges in patient management. The concurrent presence of both conditions can complicate treatment strategies, as glaucoma medications may accelerate cataract formation. This study examines the impact of glaucoma treatment on cataract progression and visual outcomes.

Methods

This prospective observational cohort study at Mahaveer Institute of Medical Sciences, Telangana, enrolled 80 adults with glaucoma and cataracts. Participants received glaucoma treatment and were monitored for IOP, visual acuity, and cataract progression over six months. Data collected at baseline, 1, 3, and 6 months were analyzed using SPSS. Ethical approval and informed consent were obtained.

Results

The study included 80 participants with glaucoma and cataracts, with a mean age of 65.4 years. Cataract progression occurred in 35% of participants, with higher rates in those with more severe baseline cataracts. Intraocular pressure (IOP) decreased significantly from 24.1 mmHg at baseline to 16.8 mmHg at 6 months (p < 0.001). Visual acuity worsened considerably over the study period (p = 0.02). Ocular side effects were reported in 31.3% of participants, but these were not significantly correlated with specific glaucoma treatments (p > 0.05).

Conclusion

The study found that glaucoma medications significantly reduce intraocular pressure but may contribute to cataract progression and a decline in visual acuity. Ocular side effects were common, though not linked considerably to specific treatments.

Recommendation

We recommend lifelong annual examinations by an ophthalmologist for patients who have had surgery for cataracts. Future studies are needed to assess the long-term glaucoma risk for patients treated with current aspiration techniques.

MANAGEMENT PRACTICES OF ADVERSE REACTIONS RELATED TO ANESTHESIA USE AMONG EYE SURGERY PATIENTS IN JINJA REGIONAL REFERRAL HOSPITAL, JINJA, UGANDA. A CROSS-SECTIONAL STUDY.

MASABA STEVEN MASAYI — 2024-12-30

Background.
Uganda, like any other developing country, bears a heavy burden of eye disease which contributes significantly to visual problems. Increasing eye surgeries, therefore, demands analyzing anesthetics to enhance patient safety. This study aimed to determine the management practices of adverse reactions related to anesthesia use among eye surgery patients in Jinja Regional Referral Hospital, Jinja, Uganda.

Methodology.
The study used a descriptive cross-sectional design and quantitative data were collected from 72 patients. A simple random sampling technique was used to pick respondents and pre-tested structured questionnaires were formulated and used to collect data.

Results.
(42%) of the patients had previous history of eye surgery, 75% of patients recovered within the first hour. (70%) of healthcare providers primarily managed adverse anesthetic reactions using medication, Oxygen therapy (14%) was used to stabilize patients with respiratory distress, vital sign monitoring (16%) ensured patient safety by tracking key indicators. Patient education (11%) helped reduce anxiety by preparing patients for potential side effects. In cases of excessive sedation, reversal agents (8%) like flumazenil were used to awaken patients.

Conclusion.
Management of anesthesia-related side effects primarily relied on medication and postoperative monitoring. While these strategies were largely effective, there is room for improvement in managing severe pain, reducing side effects, and enhancing patient education before surgery.

Recommendation.
Ensure careful titration of sedatives and monitor sedation levels closely during surgery. Increase the use of reversal agents in cases of excessive sedation to promote quicker recovery and minimize postoperative complications.

FACTORS ASSOCIATED WITH BLINDNESS AMONG DIABETIC PATIENTS ATTENDING MITYANA GENERAL HOSPITAL. A CROSS-SECTIONAL STUDY.

ALEX KISITU — 2024-12-18

Background.

Diabetes is on the rise as it is no longer a disease of predominantly rich nations. Diabetic-associated eye disease is steadily increasing everywhere, most markedly in the world’s middle-income countries including Uganda. This study assessed the factors associated with blindness among diabetic patients attending Mityana General Hospital.

Methodology.

A descriptive cross-sectional study design was adopted using a quantitative method of data collection. The study was conducted in Mityana district at Mityana General Hospital, data was collected using a structured questionnaire among 80 respondents. A probability sampling technique was used.

Results.

39 (48%) respondents were between the ages of 41 and 60, and 48 (60%) were females only. Salary was a major economic factor, and 42(52%) of the respondents earned less than UGX 100,000. 46 (57%) of the respondents were farmers by occupation. Physical inactivity was a serious lifestyle factor discussed, with 28 (35%) respondents rarely engaging in physical activities and only 13 (16%) engaging in daily physical activity.

Conclusions.

Females were most affected by blindness due to diabetic eye disease and most of the respondents are of ages 41-60 years and many are farmers by occupation. In addition, the results agreed that the highest percentage rarely engaged in physical activity.

Recommendations.

The government, through the Ministry of Health, should fund free screening of diabetic patients for diabetic-related eye complications, especially from their communities through outreaches. In addition, sensitization and education on lifestyle modification and behavior can end blindness due to diabetic-related eye disease.

COMPREHENSIVE MICROBIOTA ANALYSIS AND UV-C INTERVENTION IN EMBALMED CADAVERS: A RETROSPECTIVE STUDY ON ANATOMICAL TEACHING AND PRESERVATION

Arghya Das — 2024-12-31

Background

Post-mortem specimens used for anatomy teaching are commonly embalmed using chemical compositions to maintain tissue quality and avoid putrefaction. This study was conducted during a dissection course on embalmed dissected cadavers, involving the cultivation of samples before and after exposure to UV-C radiation to elucidate microbiota growth. This study aimed to provide scientific insights into formalin embalming, guiding future research on mitigating microbiota growth through interventions like ultraviolet-C radiation and other modifications.

Materials and methods

This retrospective study was conducted at the Department of Anatomy and Microbiology, Diamond Harbour Government Medical College and Hospital, West Bengal, India. 96 samples were collected at each step of the study.

Results

Samples were collected from six sites of two embalmed cadavers along with a cadaver transferring trolley, Mackintosh gown used for dissections & cadaver tank fluid and processed for bacteriological and mycological culture. A total number of incubations were done in 96 samples, for the growth of anaerobic, aerobic & mycological species before & after UV-C radiation on the cadaver. After UV-C exposure for one and a half hours, mycological growth was reported from only three sites of cadavers but no bacteriological growth was found in any of the samples.

Conclusion

It has been concluded from the study that there were viable bacteria and fungi found on multiple sites and surfaces of embalmed cadavers & dissection hall materials which impose significant health hazards to healthcare professionals & medical students.

Recommendations

This study recommends integrating routine UV-C radiation treatment into disinfection protocols for embalmed cadavers and dissection materials to reduce microbiota growth. Additionally, it suggests further research on the efficacy of non-toxic chemical disinfectants as a potential intervention to enhance safety in anatomical education environments.