Author Archives: pisrt

Abstract:Background: Children account for a small percentage of laboratory confirmed COVID-19 cases, with the clinical course different from the adults. The number of COVID positive cases increased from May 2020. It has been a challenge for clinicians worldwide to manage and treat COVID-19 affected patients, given the meagre information we have regarding the clinical course and the treatment protocols available.
Purpose: The purpose of this study is to analyze the clinical spectrum and outcome in children admitted with COVID-19.
Methods: This is a prospective study of children admitted to KIMS-Bangalore with confirmed COVID-19. In all cases patient demographics including history of exposure, symptoms, age, sex, address were obtained upon admission and laboratory findings were obtained from hospital records.
Results: in our study, 50 children were admitted to KIMS, bangalore. Contact history was found in 80% of the children. 20% were symptomatic without contact history. 54% children were asymptomatic, 46% were symptomatic. Of the symptomatic children, 54% had mild (with fever), 36% had moderate (fever with cough) and 8% had severe symptoms (fever, cough and breathlessness), cases between 6-12 years were –% with a slight female preponderance(54%). None of the children had known comorbid conditions. Oxygen dependency was found in 20% children. COVID was severe in 2 cases (4%), with secondary infection. No deaths were noted in our study.
Conclusion: The course of the disease in children was mild to moderate when compared to adults with no mortality. This is due to underdeveloped immune system, which have not affected the children in large extent. Asymptomatic cases have lead to underdiagnosis of COVID-19 in children, resulting in their becoming silent convalescent carriers and causing disease spread and increase in case load. Hence, it is of utmost importance that children be taught preventive measures such as usage of mask, hand hygiene by using soaps and sanitizers, avoid touching of surfaces and maintaining social distance with elderly persons in the family and surroundings. Upcoming vaccines to children are promising in ending COVID-19 pandemic.

Abstract:Background: The non-stress test is the most widely used test for the assessment of fetal health and reflects oxygenation of the brain. Fetal movements during testing are identified by maternal perception and are recorded. NST is based on the hypothesis that the heart rate of a fetus who is non-acidotic, non- impaired will temporarily accelerate in response to fetal movements. The fetal heart rate normally is increased or decreased by autonomic influences mediated by sympathetic or parasympathetic impulses from brain stem centers. NST uses minimum thresholds of FHR acceleration frequency to distinguish healthy from compromised fetuses. The value of “reactivity” or accelerations associated with fetal movement may vary considerably with the composition of the population tested, gestational age, the frequency of test repetition, and the use of other baseline FHR features in the evaluation of the test.
Methodology: The study was conducted at Department of OBGY in a tertiary care hospital in India for a duration of one year. 100 pregnant woman with pregnancy from 37 weeks to 42 weeks of gestation were included in the study. The electronic fetal monitor is used for NST. The NST was categorized as Reactive and Non -Reactive. Reactive In a 20-minute period, two or more fetal heart rate accelerations of at least 15 beats per minute above the baseline heart rate. If the NST came out to be non-reactive, NST was repeated for another 20 minutes and if it still remained Non- reactive then Biophysical profile was done for that patient and the decision was taken according to the result of the biophysical profile score.
Results: The mean age of patients was 26.72\(\pm\)4.58 years. Out of 100 NST, -67 (67%) NST were reactive while 23 (23.18%) were non-reactive. Women admitted with reactive NST had significantly higher vaginal delivery rates i.e. (42% vs. 14%). Operative delivery in non -reactive NST group was significantly higher than the reactive NST group, i.e., (86% vs. 58%). All 100 babies were born alive irrespective of the NST status and 13% (13) required NICU admission. The individual parameters of poor fetal outcome like meconium stained liquor, Apgar score <7 at 5 minutes had increased incidences in the non-reactive group.
Conclusion: The “NST at admission” is a straightforward and uncomplicated procedure for determining the fetal status antenatally. Its responsiveness ensures a positive outcome for both the mother and the fetus, while non-responsiveness raises the risk of operative delivery and NICU hospitalization.

Abstract:Background: A retrospective study of records of 113 patients presenting to a tertiary care hospital during the 2nd wave of the COVID-19 pandemic was carried out with an aim to study the clinical profile of rhinoorbitocerebral mucormycosis (ROCM) patients.
Results: Out of 113 patients, 80 were males and 33 were females with a male-to-female ratio of 2.42:1. The most common age group affected was 51-60 years for both males (n=24) and females (n=37). The most common clinical presentation was headache (n=80) followed by ptosis, proptosis, and ophthalmoplegia (n=77). Based on radiology, all patients had nose and paranasal sinuses involvement, 71.68% had orbital involvement, and 13.27% had intracranial involvement. The most common extrasinus involvement was maxillofacial soft tissue. 89% were either COVID positive or COVID like on HRCT or post-COVID. Only 11% had no history of COVID or COVID like on HRCT (High Resolution Computed Tomography). 83 were diabetic, 55 had kidney disease, and 38 were hypertensive. 45.13% of patients had a history of steroid use, 21.23% had used oxygen, and 4.42% had a history of ventilator support.
Conclusion: Mucormycosis is a multi-system fungal infection with a significant surge in incidence in the second wave COVID era, which suggests a possible correlation of COVID infection with mucor. Uncontrolled diabetes is the commonest risk factor for mucor infection. The disease primarily involves the nose and paranasal sinuses, extending to the surrounding areas. MRI with contrast is the gold standard diagnostic modality to define the disease extent. Retromaxillary fissure involvement is an important cause for ophthalmoplegia in the majority of patients. Limited endoscopic orbital debridement with preservation of the globe avoids gross disfigurement and mental trauma to the patients. Early diagnosis with aggressive anti-fungal treatment combined with surgical debridement results in improving overall prognosis and survival in post-COVID mucormycosis patients.

Abstract:Background: Benign Paroxysmal Positional Vertigo is the most frequent vestibular disorder characterized by brief episodes of vertigo caused by changes in the position of a person’s head. It significantly affects the quality of life of elderly patients by interrupting their daily activities.
Methodology: The study was conducted at the Department of E.N.T, Kempegowda Institute of Medical Sciences. Sixty patients who fulfilled the inclusion criteria were included in the study. Patients were evaluated through proper history taking using a proforma and clinical examination. The Dizziness Handicap Inventory scoring system was used, and baseline (pre-treatment) scores were recorded. Patients were asked to come back after 3 weeks for follow-up (post-treatment) and then after 3 months for further follow-up.
Results: The mean age of subjects in the Epley’s manoeuvre group was 43.60 years, while it was 40.97 years in the Brandt Daroff’s exercise group. Among skilled workers in this study, tailors were most often affected, and the vibration associated with their work may be considered as one of the etiologies. The mean total symptom scores decreased in both treatment groups after the study period. There was a considerable reduction in the scores of physical, emotional, and functional symptoms in both groups. A marked reduction in emotional scores was observed in group I compared to group II in the post-treatment and follow-up assessments.
Conclusion: Epley’s manoeuvre is superior in relieving vertigo in patients with BPPV compared to Brandt Daroff’s exercise.

Abstract:Background: Coronavirus disease 2019 [COVID 19] is caused by severe acute respiratory syndrome coronavirus 2[SARS-CoV-2] and was declared a global pandemic in March 2020. The impact of coronavirus disease 2019 on maternal and fetus health is unclear. We performed an observational study to determine the association between SARS-CoV-2 infection and adverse pregnancy outcomes, including preterm birth and stillbirth.
Materials and methods: Study is carried out in covid ward of the Department of Obstetrics and Gynaecology at Bharati Vidyapeeth Medical College and Hospital, Sangli. This is a retrospective study involving all pregnant patients admitted in the covid ward of our hospital from April 2021 to December 2021. Information regarding age, parity, condition of the patient at the time of admission to covid ward in terms of oxygen saturation, mode and time of delivery, outcome of pregnancy, fetal outcome and maternal morbidity and mortality were noted and analysed.
Results: From analysis of available data maternal hypoxia and fetal distress were the most common indications for caesarean section. Caesarean section accounted for 86.6% of all deliveries, successful vaginal delivery were reported in 2 out of 15 deliveries, rest 3 cases were reported as missed abortion and D&E was done.
Conclusion: Covid 19 infection in pregnancy may be associated with increased risk of caesarean section, preterm birth, increased morbidity and mortality.

Abstract:The study aimed to investigate the impact of sleep on daily activities, academic performance, and various factors influencing sleep quality. The Pittsburgh Sleep Quality Index (PSQI) scale was used to collect data from 171 randomly selected medical students. Descriptive and inferential statistical analyses were performed to analyze the data. Results revealed that 40.9% of the study subjects had poor sleep quality, while 59.1% had good sleep quality. No significant association was found between sleep quality and socio-demographic factors or habits. However, statistically significant associations were observed between sleep quality and academic performance indicators, such as feeling of not doing enough, unsatisfactory results, and failing in exams. The study emphasizes the importance of adequate sleep for medical students given their demanding academic and professional roles and suggests that poor sleep quality can negatively impact academic performance. The prevalence of poor sleep quality among medical students may vary across countries due to differences in sample methods, academic stress levels, and social environments. Overall, the findings highlight the need to address sleep-related issues among medical students to improve their well-being and academic success. Further research is required to better understand the complex relationship between sleep quality, gender, socio-demographic factors, and psychological variables.

Abstract:Background: Osteoarthritis (OA) is a degenerative joint disease that affects the cartilage and surrounding tissues. This study aimed to compare the efficacy of oral native collagen type 2 and oral glucosamine sulphate in patients with grade 2 and grade 3 primary knee osteoarthritis.
Materials and Methods: This was a randomized observational prospective study conducted on patients aged 30 years or above, of any gender, diagnosed with primary knee osteoarthritis of grade 2 and 3. The patients were randomly assigned to two groups using computer randomization software. Group 1 received native type 2 collagen 40 mg (Tablet Dupact 40 mg, Wockhardt Limited), while Group 2 received oral glucosamine 1500 mg (Lubrijoint 750 mg twice daily).
Results: The majority of participants in the Glucosamine group were in the 51-60 years age group (32.5%), while the majority in the Collagen group were slightly younger, belonging to the 41-50 years age group (30%). The mean age of the Glucosamine group (57.2 \(\pm\) 10.45 years) was similar to the Collagen group (57.2 \(\pm\) 11.39 years), and the difference was not statistically significant. The pre-treatment and post-treatment (after 12 weeks) C-reactive protein (CRP) values did not show a statistically significant difference between the two groups. However, both the Glucosamine and Collagen treatments resulted in a significant reduction in WOMAC score and visual analog scale (VAS) score over the course of the 12-week treatment.
Conclusion: Both Glucosamine and Collagen treatments showed improvements in reducing painful and swollen joints, as well as significant improvements in VAS and WOMAC scores.

Abstract:Background: Intertrochanteric and subtrochanteric fractures are typically treated with proximal femoral nails. Proximal femoral nails come in two types: regular PFN (which consists of 2 proximal screws) and PFNA2 (which consists of a single proximal screw).
Aim: The aim of our study is to compare functional outcomes and implant-related complications in patients treated with regular PFN versus PFNA2 for intertrochanteric and subtrochanteric fractures.
Material and Methods: A prospective observational and randomized study was conducted with a total of 40 patients with intertrochanteric and subtrochanteric femoral fractures admitted to Bhaskar Medical College Hospital. After fulfilling the inclusion criteria, the patients were divided into two groups randomly, with 20 cases in each group. They were treated with regular PFN and PFNA2, respectively.
Conclusion: Based on the study, we concluded that PFNA2 reduces surgery time, blood loss, and radiation exposure compared to regular PFN. PFNA2 also has a higher union rate with significantly better functional outcomes compared to regular PFN. Patients treated with PFNA2 can bear weight early. Implant-related complications such as screw backing out and cut-through of screws in the femoral head (z-effect and reverse z-effect) are not observed with PFNA2. Therefore, we conclude that PFNA2 is superior to regular PFN.

Abstract:Background: Infected non-union and gap non-union are challenges that orthopaedic surgeons have to face globally. The open fracture is the most common cause of infected nonunion and tibia is the most commonly involved bone in the infected nonunion. In Ilizarov technique, vascularity is increased by corticotomy and application of a circular external fixator. It also provides micro motion due to distraction and gives an excellent biological environment for fracture healing.
Material and Methods: Seventeen consecutive patients with infected nonunion of long bones were treated from 2012 to 2016. The age range was 20 to 65 year-old male patients. Five cases were admitted with femoral infected non-union and twelve with septic non-union of tibia. Patients were followed up for one year. The predominant bacteria were Staphylococcus aureus and Pseudomonas aeruginosa. Average duration of antibiotics treatment was 4.9 (range, 2-6) weeks. The outcome measures were according to the classification of ASAMI, which is based on radiological (defect filling) and clinical (functional) findings.
Results: The cases were followed with mean period of 3.5 years (range, 2-5 years). In the present study, seventeen cases with septic non union of tibia and femur were evaluated. All cases completed treatment and achieved bony union with no signs of infection. In the present study, bone union result as per ASAMI score was excellent in 76.5%, good in 23.5% cases, and also the functional results were excellent in 76.5%, good in 23.5% cases. No patient had gone for amputation in our study.
Conclusion: Ilizarov technique has been a successful treatment for infected long bone non unions of tibia and femur associated with bone loss. Our results were similar with the existing literature about the study. The lengthy treatment time and considerable number of complications must be fully understood both by the surgeon and the patient before undertaking the ilizarov treatment method.

Abstract:Background: Breast cancer is the most common malignancy among women worldwide. According to the GLOBOCAN 2020 estimates of cancer incidence and mortality, female breast cancer has surpassed lung cancer and is now the most commonly diagnosed cancer, with an estimated 2.3 million new cases. In India, breast cancer has moved from being the fourth most common cancer in the 1990s to the first. The prevalence of established hormonal and reproductive risk factors is higher in Western countries, but these risk factors are not commonly observed in the rural population of India. Therefore, it is important to study the probable risk factors in our population, including the potential role of obesity, especially in postmenopausal women, in the development of breast cancer.
Aim and Objectives: The aim of our study is to determine the demographic profile of breast cancer patients and identify any associated risk factors for breast cancer in this population.
Methods: This analytical cross-sectional study was conducted at Alluri Sita Rama Raju Academy of Medical Sciences (ASRAM) over a period of one year from March 2021 to February 2022. We included 72 patients with histologically proven breast carcinoma who attended the Oncology OPD and met the inclusion criteria.
Results: In our study, approximately 86% of breast cancer patients had a body mass index (BMI) greater than 23. Obesity is known to be associated with increased estrogen levels, which can be a risk factor for hormonal-dependent breast cancer. Among the study group, 52% were luminal positive, 25% were triple negative, and 22.2% were HER2 neu positive.
Conclusion: Our study found that approximately 86% of breast cancer patients were obese. The association between BMI and breast cancer needs to be further studied in randomized control trials. Furthermore, reproductive and hormonal risk factors were not significantly observed in our population group.