Author Archives: pisrt

Abstract:Background: In India, the most common elective surgery is inguinal hernia repair, which consumes a significant amount of healthcare resources. This observational study investigates the demographics, clinical profile, and risk factors of inguinal hernia at a tertiary-level institute in northern India.
Methods: This observational study was conducted at a tertiary care center in northern India, involving 98 patients attending the surgical outpatient department for inguinal hernia repair. After obtaining informed consent from all participants, demographic information, medical history, and clinical examinations were recorded. This study followed a single-center, prospective, non-randomized observational design.
Results and Discussion: In our study, 39 patients (39.8%) were over the age of 50. Ninety-four patients (96%) were male, while four (4%) were female, resulting in a male-to-female ratio of 24:1. The higher prevalence of males can be attributed to their participation in more strenuous exercises, weightlifting, and anatomical differences. Among the identified risk factors, lifting heavy weights accounted for 52% of cases, followed by respiratory disease (37.7%) and altered bowel habits (34.6%). Smoking and diabetes were also found to be associated with an increased risk of hernias. In terms of hernia location, the right side was most common (62.2%), followed by the left side (32.6%), with 5.1% of patients having bilateral hernias. The most common type of hernia observed was the indirect hernia.
Conclusion: Inguinal hernia is a common surgical problem, predominantly seen in elderly males. Right-sided inguinal hernias are more prevalent, with the indirect type being the most common. Heavy and strenuous activities were frequently identified as significant risk factors.

Abstract:Introduction: Immunization is the most effective preventive measure in reducing mortality and morbidity due to communicable diseases. The success of a universal immunization program depends on the proper conduction of session sites, which in turn relies on proper planning, availability of logistics, and the competence of the manpower involved. This study aims to evaluate the session sites based on the aforementioned aspects.
Methods: This cross-sectional study was conducted across 24 randomly selected immunization sessions in 8 districts of Ganjam district. Data on resources-logistics readiness, sociodemographic profile, knowledge, and practice of the Auxiliary Nurse Midwives (ANMs) regarding various aspects of immunization were collected using two structured questionnaires. The collected data were compiled and analyzed using SPSS ver. 17.
Results: A total of 24 immunization sessions were observed in 8 blocks of Ganjam district. Immunization sessions were held according to the microplan at all sites, while beneficiary due lists were found at 18 (75%) sites. Only 6 (25%) sites had at least one vial from each vaccine. The date and time of opening the vial were recorded at 17 (70.8%) sites. Beneficiaries were advised to wait for 30 minutes at 11 (45.8%) sites, while 4 key messages were given by 15 (62.5%) of ANMs. Most ANMs were able to correctly interpret the Vaccine Vial Monitor (VVM) and were aware of which vaccines follow the open vial policy.
Conclusion: Adequate manpower was available at almost all sites, while unavailability of vaccines and logistics was observed at a few sites. The knowledge and practice of vaccinators can be improved through periodic hands-on training.

Abstract:Introduction: Sore throat following endotracheal intubation is a long-standing concern for anaesthesiologists worldwide.
Objectives: To determine the occurrence of post-intubation sore throat and associated risk factors in patients undergoing surgeries under general anesthesia.
Materials and Methods: A total number of 400 patients, ASA Grade I and II, aged between 18 to 75 years of either gender posted for surgery under general anesthesia were selected. Body Mass Index and history of smoking were noted. Intubation-related factors including technique, number of attempts, size of endotracheal tube, Cormac-Lehane grade, need for external laryngeal pressure during intubation, endotracheal tube cuff pressure, duration of surgery, patient position during surgery, and coughing during emergence were observed to determine the relation of sore throat with the above factors in patients undergoing surgery.
Results: The results from this study showed that intracuff pressure at intubation (p value 0.009), extubation (p value 0.001), and cough at emergence had significant association with sore throat by multivariate analysis (p value 0.001). Number of intubation attempts, duration of surgery, body mass index of patients, and need of external laryngeal pressure during intubation had significant association with sore throat by bivariate analysis (p value \(\leq 0.05\)).
Conclusion: The discomfort in patients in the postoperative period due to sore throat occurs due to a number of factors. Endotracheal tube cuff pressure at intubation and extubation, and cough at emergence being significant among them.

Abstract:Introduction: Elastography has emerged as a valuable diagnostic method for assessing the integrity of the pelvic floor muscles. It measures tissue stiffness and deformation in response to compression, providing a non-invasive and objective assessment of tissue stiffness using gray-scale ultrasonography. In this study, we aim to evaluate the clinical outcomes and elastographic changes following Pelvic Floor Muscle Training (Kegel Exercises) among patients with Pelvic Organ Prolapse in Stage 1 and Stage 2.
Materials & Methods: Patients eligible for the study were enrolled after obtaining written informed consent, ensuring the confidentiality of their details. Detailed history, general examination, systemic examination, and local examination were performed following standard protocols. Per speculum examination was conducted to determine the degree of prolapse based on POP-Q staging. Transperineal Elastography was performed on women diagnosed with Stage 1 or Stage 2 POP to evaluate Pelvic floor dysfunction. Study participants were instructed on how to perform Kegel exercises and were followed up. Clinical and elastography scores were recorded and analyzed.
Results: Out of 120 subjects, 56 had a clinical score of 3 (46.7%) and 52 had a clinical score of 4 (43.3%) at the 1st month evaluation. For elastography scores, 60 subjects had an ES2 score (50%) and 60 had an ES3 score (50%). After 6 months of performing Kegel exercises as prescribed, 44 subjects had a clinical score of 1 (36.7%), 32 had a clinical score of 2 (26.7%), and 44 had a clinical score of 3 (36.7%). In terms of elastography scores, 48 subjects had an ES4 score (40%), 48 had an ES3 score (40%), and 24 had an ES2 score (20%). There was a statistically significant difference between the baseline clinical and elastography scores and the scores at 6 months (p<0.05).
Conclusion: The results of this study indicated that pelvic organ prolapse stage and levator ani distension in women were correlated with the elasticity properties measured by elastography. Further research is required to explore the relationship between pelvic floor elasticity characteristics and clinical data.

Abstract:Objectives and methods: The present study is a Prospective study of clinico-pathologic patterns, in women 40 years and below, with ovarian cancer undertaken in Srinivasan Medical College Hospital and Research Centre over a period of 36 months.
Inclusion Criteria: Patients $\leq$ 40 years with histologically proven ovarian cancer and Primary ovarian cancers \textbf{Exclusion Criteria:} Patients above age 40 years, Those who did not have cancer ovary on final histopathology, Patients who were treated with chemotherapy only and not operated. 115 patients were retrospectively enlisted for our study out of which 93 could fulfil our inclusion criteria.
Results and conclusion: Even in women 40 years and less, 70% of the ovarian tumors were epithelial in histological type. Serous ovarian cancer was the most common. Germ cell tumor constituted 20% of the ovarian cancers. Mixed malignant germ cell tumor was the commonest type. The mean overall survival was 5.4 years. The overall survival was 87%. For epithelial tumors it was 82% and for non-epithelial tumors it was 96%. For early stage disease it was 100% but for advanced stages it was 73%.

Abstract:Coronary artery disease (CAD) is a significant health concern among females, and understanding its modes of presentation and clinical profile is crucial for effective management. This prospective cross-sectional study was conducted at the Department of General Medicine, Sri Venkateshwaraa Medical College Hospital and Research Centre, Ariyur, Puducherry, from May 2022 to April 2023. The study aimed to explore the various modes of presentation and clinical characteristics of CAD in females. The inclusion criteria consisted of female patients above 40 years with hypertension, diabetes mellitus, and dyslipidemia, while patients with congenital heart disease, rheumatic heart disease, structural heart disease, or electrical abnormalities were excluded. A total of 100 female patients presenting with symptoms, signs, and electrocardiogram (ECG) changes suggestive of CAD, along with elevated biochemical markers, were included as cases. The results revealed that 33% of the patients belonged to the age group of 60-70 years. Age was found to be a significant risk factor for CAD mortality among women, with increasing age correlating with a higher incidence of hypertension, diabetes, obesity, and dyslipidemia. The most common mode of presentation was chest pain, highlighting the importance of recognizing this symptom in the evaluation of CAD in females. Furthermore, systemic hypertension and diabetes mellitus were identified as additional risk factors for myocardial infarction (MI) in this population. In conclusion, this study underscores the need for early recognition and understanding of the various modes of presentation and clinical characteristics of CAD in females. Chest pain, along with systemic hypertension and diabetes mellitus, emerged as important factors to consider in the evaluation and management of CAD in this population.

Abstract:Objectives: There is a lot of evidence that oxidative stress plays a role in the etiology of aging. PON-1 is mostly complexed to HDL and is responsible for its antioxidant properties. This investigation was undertaken to assess age-dependent changes in plasma PON-1 concentration and its association with age, HDL, BMI, and duration of diabetes among T2DM patients.
Methods: This study was carried out on 125 clinically diagnosed T2DM patients (young and middle-aged) attending the OPD and IPD of Rohilkh and Medical College and Hospital. Laboratory investigations such as fasting plasma glucose (FPG), HbA1c, and plasma PON-1 were measured.
Results: When compared with young patients, middle-aged patients showed a significantly declined plasma PON-1 (p < 0.01) and HDL (p < 0.05) levels and increased BMI (p < 0.05). The young and middle-aged patients showed a negative correlation of PON-1 with BMI (p < 0.01), duration of diabetes (p < 0.01), and a positive correlation with HDL (p < 0.01). However, only middle-aged diabetic patients showed a significant correlation of PON-1 with FPG (p < 0.01) and HbA1c (p < 0.01).
Conclusion: Decreased PON-1 concentration in middle-aged patients might be due to a decrease in HDL levels as a consequence of oxidative stress since PON-1 is mainly complexed to HDL.

Abstract:Objective: To evaluate fertility outcomes on ovulation induction with clomiphene citrate versus letrozole among anovulatory Polycystic Ovarian Syndrome (PCOS) women.
Material and Methods: This randomized controlled study was conducted in the infertility clinic of our institute between 2015 to 2018. 106 subjects from 18-39 years, BMI \(<\) 30 kg/m\(^2\), anovulatory infertility, at least one patent fallopian tube, diagnosis of PCOS, and male partner sperm concentration of at least 15 million/ml were included. These subjects were randomly allocated into 2 groups. One group was given letrozole and the other group clomiphene citrate. Follow-up with serial transvaginal ultrasonography was done for follicular growth. Inj. Human chorionic Gonadotropin (hCG) was administered 36 hours prior to ovulation as predicted by folliculometry, and a check scan was done for ovulation. The result was evaluated in terms of the number of follicles, ovulation rate, endometrial thickness from D11 to D14, successful pregnancy outcome, complications, and failure.
Results: A total of 106 patients were included, 52 cases were treated with Letrozole and 54 cases with clomiphene. Most subjects in either group had oligomenorrhea (57.4% & 61.4%) with regular cycles. Ovulation occurred in 27 (51.9%) subjects with letrozole and 18 (33.3%) with clomiphene. Successful pregnancy outcomes were seen in 24 out of 52 (46.1%) with letrozole and 16 out of 54 (29.6%) with Clomiphene.
Conclusion: Successful pregnancy outcome was higher with letrozole despite a lesser number of mature follicles. Clomiphene citrate could be replaced by Letrozole as the key medication for chronic anovulation in PCOS.