A study of causes of infertility and its associated risk factors in tertiary care centre

TCMS-Special issue: Indian Medical Research Views and Findings on Last 5 years (2023), pp. 270 – 275 Open Access Full-Text PDF
Dr. Shrishty Shrivastava, Dr. Surabhi Kuhikar and Dr. Kavita Chandel

Abstract:Background and Aim: The condition of infertility is recognised as a major healthcare concern across different communities. The issue’s significant prevalence has resulted in its intensified importance. Environmental conditions and acquired risk factors have been found to be associated with a substantial proportion of cases of infertility. Diverse environmental conditions have underscored the necessity to investigate the distinct aetiologies of infertility in various regions.
Objective: The aim of this study was to determine the frequency causes of infertility in infertile couples.
Materials and Methods: In this cross sectional descriptive study 340 infertile couples that were referred to infertility clinic of tertiary care hospital during study period, were examined. This centre is the only governmental centre for infertility. Information about the patients was obtained from medical examinations and laboratory findings. To analyze the data, descriptive statistics such as frequencies and the mean were used.
Results: Among the various causes of infertility women factors (88.6%) had the highest regard. In the causes of female infertility, menstrual disorders, diseases (obesity, thyroid diseases, and diabetes), The causes of infertility in the 340 couples were divided into four standard categories as follows: Female factor 58.7% , Male factor 28.2%, Combined causes 3%, Unexplained infertility 10.1%. The prevalence of primary and secondary female infertility was 70.5% and 29.5% respectively. Tubal cause account most in female infertility.among male sperm morphology was measure cause.
Conclusion: Urban Central India has a lower rate of primary infertility than developing nations. Healthcare professionals and policymakers must understand infertility incidence and risk factors to develop and implement various infertility prevention and management strategies.

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A randomized control study to determine risk of surgical site infection after prophylactic negative pressure wound therapy for closed surgical incisions in a tertiary care centre of central India

TCMS-Special issue: Indian Medical Research Views and Findings on Last 5 years (2023), pp. 262 – 269 Open Access Full-Text PDF
Dr. Sunil Kumawat, Dr. Sonia Moses, Dr. Sachin Verma, Dr. Shashi Shankar Sharma and Dr. Avinash Gautam

Abstract:Background and Aim: Surgical site infections (SSIs) are common after laparotomy wounds and are associated with a significant economic burden. The use of negative pressure wound therapy (NPWT) has recently been broadened to closed surgical incisions.
Material and Methods: The Institutional Ethics Committee approved this single-center, parallel, randomised controlled trial, which followed the Declaration of Helsinki. If they were 18–65 year old , patients were eligible. All surgery patients undergoing abdominal surgery and closed abdominal surgical wounds who received negative pressure wound therapy or conventional therapy. Exclusion criteria included abdominal pathology re-explored or re-operated and inability to consent. Trial participants received an information leaflet and gave written consent.
Result: The primary objective to assess the relative risk of development of SSI in the ciNPWT, the relative risk of development SSI in CiNPWT group was found to be 0.69 and 1.44 in group with conventional dressing, thus CiNPWT was found to be protective for SSI in incisional wound. CiNPWT and conventional patients were mostly 31-60 years old. 84 patients (70%) were male, while 36 (30%) were female in the study cohort.NPWT reduced wound complications like soakage and dehiscence by 20% on the 14th day after surgery. A 0.013 p-value indicated statistical significance. NPWT reduced wound complications like soakage and dehiscence on the 21st day after surgery. The 18.33% reduction was statistically significant at 0.0134. Negative Pressure Wound Therapy (NPWT) reduced soakage and dehiscence by 10% in serial follow-ups on the 30th day post-surgery. The study revealed a negative correlation between the levels of Total Serum Protein and Serum Albumin and both wound healing duration and duration of hospital stay. Specifically, lower levels of total protein and albumin were associated with longer healing time and extended hospitalisation.
Conclusion: Surgical site infections are common, especially in high-risk patients. SSI costs hospitals a lot. SSI research is underway. This study used Negative Pressure Wound Therapy (NPWT) as a prophylactic dressing for closed incisional wounds in 60 patients and compared its efficacy to conventional dressings. Based on relative risk analysis, CiNPWT prevented SSI after one year. NPWT significantly reduced seroma formation. Negative Pressure Wound Therapy (NPWT) shortened wound healing and hospitalisation. Negative pressure wound therapy (NPWT) reduced wound complications like dehiscence, blistering, necrosis, and reoperation or rehospitalization. These findings were not statistically significant. NPWT reduced SSI.

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Clinical profile of non-alcoholic fatty liver disease: A cross-sectional study

TCMS-Special issue: Indian Medical Research Views and Findings on Last 5 years (2023), pp. 255 – 261 Open Access Full-Text PDF
Dr. Sarita Jalodiya, Dr. Pankaj Kumar Jain, Dr. Mohit Garg and Dr. Arun Kumar Pargi

Abstract:Introduction: In many Western countries, non-alcoholic fatty liver disease (NAFLD) is now surpassing viral hepatitis as the primary cause of chronic liver disease and hepatocellular carcinoma (HCC). In India, the current high burden of NAFLD is likely to rise further in the future. Given the significant prevalence of NAFLD in the community, identifying those at risk of developing liver disease is critical in order to simplify referral and advice effective management. Thus, the present study was carried out with the aim to diagnose Non-alcoholic fatty liver disease based on ultrasound and study its clinical profile in patients attending outpatient clinic and inpatients in a tertiary care hospital in Central India.
Material and Methods: This observational study was carried out in the Department of Medicine, Netaji Subhash Chandra Bose Medical College and Hospital, Jabalpur, after approval by Institutional Ethics Committee. 100 consented patients,>18 years of age presenting to the OPD and IPD of the hospital and suspected and later diagnosed as NAFLD were included in the study using a proforma, ultrasonography and investigations. Data was collected, compiled and analysed using SPSS 22.0 (trial version).
Results: 68%, 27%, 5% cases were diagnosed as grade I, grade II and grade III fatty liver respectively. The mean age was 47.07\(\pm\)11.95 years. Female preponderance was observed (55%). Abdominal pain (55%), fatigue (73%) and dyspepsia (48%) were the dominant symptoms. 51% patients had increased waist circumference (mean =87.06\(\pm\)10.46 cm). Mean BMI was 26.77+4.01 kg/m2. 46% were pre-obese and 15% were obese (BMI >30). Majority of Grade III fatty liver (60%) were diabetics. Mean values of impaired fasting blood sugar in grade I, II, III were 109.6\(\pm\)45.02, 117.52\(\pm\)56.93, 138.20 \(\pm\)53.31 mg/dl and when compared was statistically significant (p<0.05).29% patients had hypertension (\(\geq\)130/85 mmHg. 18% patients had high bilirubin levels. Deranged AST (46.48\(\pm\)27.30) and ALT (57.51\(\pm\)52.10) were found in greater percentage of patients (p value <0.001, <0.001 respectively) and had positive co-relation (r+0.36 and r+0.43). Hypercholesterolemia (>200mg/dl) was found in 46% patients. Mean cholesterol level in grade I, II and III was 192.71\(\pm\)43.43, 210.37\(\pm\)44.11 and 277.34\(\pm\)34.06; when compared it was found to be statistically significant (p< 0.01) with positive co-relation (r+0.39).Hypertriglyceridemia (>150mg/dl) was present in 60% cases. The mean triglyceride level in grade I, II and III was 160.46\(\pm\)51.28, 211.00\(\pm\)111.432 and 240.14\(\pm\)174.111 mg/dl respectively and when compared was statistically significant (p<0.05) with positive co-relation (r+0.29). Low HDL was present in 71% of patients. HDL cholesterol had a negative co-relation (r-0.17). In the present study mean LDL was 119.66+31.11 mg/dl and elevated LDL (>130mg/dl) was found in 29% of patients. Elevated VLDL was seen in 36% of patients with mean of 30.496+10.33 mg/dl.
Conclusion: Non-alcoholic fatty liver disease (NAFLD) is a leading cause of chronic liver disease in both the developed and developing worlds. It is emerging as a major public health problem. The present study throws light on the clinical spectrum of the disease. Early detection and treatment is of utmost importance in preventing this disease from emerging as a new epidemic globally.

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Clinical profile and outcome of multisystem inflammatory syndrome in children (MIS-C) related to COVID-19 infection: A single center retrospective study

TCMS-Special issue: Recent developments of medical and surgical research (2023), pp. 601 – 606 Open Access Full-Text PDF
Hardik Patel and Sara Dhanawade

Abstract:Background and Objectives: Multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19 is a hyper inflammatory syndrome manifesting commonly with a cytokine storm that causes wide spread multi organ involvement.
Aim: To study the clinical profile & outcome of multisystem inflammatory syndrome in children (MIS-C) related to covid-19 infection.
Methodology: This retrospective study was done in Pediatric Intensive Care Unit of a tertiary care teaching hospital. Case records of children with discharge diagnosis of MIS-C, full filling the WHO criteria were included. The cases were categorized into two subsets based on presentation: with shock and without shock. Demographic parameters, clinical symptomatology, laboratory parameters, echocardiography findings and treatment were compared between these two groups. Coronary artery diameter was measured by using Z score in echocardiography. Outcome of the study was measured in terms of mortality or discharged.
Results: During the study period, 96 children presented with signs and symptoms suggestive of MIS-C and out of them 63 children fulfilled the WHO MIS-C criteria. The mean age of study population was 6.8 \(\pm\) 5.31years (1 month-17 years). Majority of cases were in the age group of 0-5 years (47.61%) with male preponderance of 55.55%. Half (50.79%) of the children presented with shock and maximum cases were in 6-12 years of age group (p=0.008). Most common presenting symptoms were vomiting and rash observed in 58.73% children each. C reactive protein (p=0.001) and Sr Ferritin (p=0.009) were significantly higher in children with shock. Echocardiography was done in 38 children and 30(78.94%) of them had abnormalities. Left ventricular dysfunction was significantly higher in children with shock as compared to those without shock (p=0.02). Majority of children who presented with shock required IVIg along with steroids as against those presented without shock(p=0.003). Mortality was 12.7%.
Conclusion: Shock was a common manifestation in MISC, affecting half of the children. CRP, Sr ferritin and echocardiography abnormality were significantly higher in children with shock. Majority of the children with shock required IVIg along with steroids.

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A comparative study of the efficacy between conventional and ultrasound-guided brachial plexus block in the upper limb surgeries at our centre (ASRAM)

TCMS-Special issue: Recent developments of medical and surgical research (2023), pp. 589 – 600 Open Access Full-Text PDF
Harish Gautam P, Shailaja K and Manoj Remella

Abstract:Background: Upper limb surgeries can be performed by the administration of general anaesthesia or regional nerve blocks. Brachial Plexus Block either conventional or Ultrasound-guided is preferred to general anaesthesia.
Aim and Objectives: This study was designed to compare the conventional paresthesia technique with an ultrasound-guided approach for supraclavicular brachial plexus block with regard to the onset and duration of sensory and motor block, success rate, and incidence of complications.
Methods: The study was conducted in the operation theatre complex in Alluri Sitarama Raju Academy of Medical Sciences (ASRAM) over a period of one year, from January 2022 to December 2022.
Results: Ultrasound-group had a significantly longer duration of motor block and sensory block when compared to the conventional approach.

Conclusion: In conclusion, ultrasound-guided approach for supraclavicular brachial plexus block is superior to conventional block with longer duration of sensory and motor block, decreased analgesic requirements and lesser incidence of complications.
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Hyperhomocysteinemia and paediatric stroke: A case series

TCMS-Special issue: Recent developments of medical and surgical research (2023), pp. 584 – 588 Open Access Full-Text PDF
Anuja Sonika, Kinikar Utkarsha S and Dhanawade Sara S

Abstract:Background: Cerebrovascular disease in children is a rare occurrence with an annual incidence of 2.7/100,000 children. There are limited reports revealing stroke in pediatric population associated with hyperhomocysteinemia. We present a series of cases discussing the clinicolaboratory, radiological findings and management of children presenting with hyperhomocysteinemia and stroke.
Aim and Objective: To study the clinicolaboratory profile, radiological findings and outcome of children with hyperhomocystienemia and stroke.

Methodology: This is a retrospective observational study where case records of paediatric patients (<18 years) who had stroke associated with Hyperhomocysteinemia were studied. Over the last five years, seven were diagnosed with hyperhomocystienemia associated with paediatric stroke.
Results: Out of the seven patients, six of them presented with headache and hemiparesis, one presented with convulsions. Mean age of presentation was 9 $\pm$1.5 years. Neuroimaging in all suggested acute cerebrovascular infracts. All had elevated homocysteine levels and five had documented low vitamin B12 levels. MTHFR gene was positive in one patient. Bilateral lens dislocation was observed in three of them. Intellectual disability was observed in four of these patients, and marfanoid features were seen in three of them. All the patients were started on low dose aspirin and polyvitamin therapy. Four patients had complete recovery, one is still improving and one was lost to follow up. Recurrence was observed in one patient.
Conclusion: Commonest symptoms were headache and hemiparesis. Manifestations of hyperhomocysteinemia can start in infancy. Homocystiene estimation should be included in work up of paediatric stroke and polyvitamin therapy should be included in management.
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Evaluate the improvement in post-operative quality of life of incisional hernia patients repaired by conventional ventral hernioplasty with regards to physical pain, Functional ability and cosmesis

TCMS-Special issue: Recent developments of medical and surgical research (2023), pp. 576 – 583 Open Access Full-Text PDF
Saroj Kumar and Rakesh Kumar Verma

Abstract:Background: Incisional hernia (IH) is a frequent complication of open abdominal surgery. Patients with Incisional hernia present with symptoms such as pain, discomfort, limitation of routine activities, skin problems, strangulation of hernia content etc. It is one of the most frequent long-term complications of abdominal surgery and it continues to be a significant problem for patients as well as surgeon.
Methodology: The study was conducted at R. G. Kar Medical College & Hospital; Department of General Surgery. 50 elective patients having ventral hernia who have undergone conventional open ventral hernioplasty were included in the study. All the patients were given a Questionnaire initially in the pre-operative stage and subsequently in the 1st and 7th post-operative day and later on during 1st month and 6th months of post-operative follow up.

Results: In our study pain was the major concern of the incisional hernia patients. Initially 14% of patients were free of pain and rest 86 % were symptomatic for some pain. 14% out of these were having severe pain preoperatively. At one-month post-operative follow up in our series 11 (22%) remained symptomatic for mild to moderate pain. After 6 months of follow up number of patients having pain remains approximately the same. 11(22%).
Conclusion: By 6 months, postoperative symptoms (pain, activity limitation, and overall QOL) are significantly better when compared with preoperative findings and 1-month follow-up levels.
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Prevalence of nasal colonization of MRSA in a teaching hospital

TCMS-Special issue: Recent developments of medical and surgical research (2023), pp. 569 – 575 Open Access Full-Text PDF
Mamatha P Samaga, Sahana Shetty N S and Keerthi A M

Abstract:Background: MRSA is one of the leading causes of infections among hospitalized patients. The present study was conducted to know the prevalence of nasal colonization of MRSA in hospitalized patients.
Methodology:

Study design: A cross sectional study.
Study setting: Department of Microbiology, MIMS, Mandya, and
Source of data: Inpatients of MIMS teaching hospital, Mandya irrespective of any departments.
Method of collection of data: A proforma was used to record information on the Socio Demographic factors of the subjects including age, sex, presence of chronic disease, hospitalization within the previous year, use of antibiotics prior to a month of the sample collection, pattern of routine hygienic practices of the subjects. A total of 300 subjects were screened for MRSA after obtaining informed written consent from the subjects.
Results: Out of 300 Inpatients, 148(49.3%) were culture positive for Staphylococcus aureus,52 (17.3%) were MRSA carriers, Out of 52 MRSA isolates from Inpatients, all the 52(100%) isolates were sensitive to Vancomycin and Linezolid. 34(65.3%) were sensitive to Gentamicin, 24(46.1%) to Tetracycline, 23(44.2%) to Ciprofloxacin and 19(36.5%) to Chloramphenicol. All the 52(100%) isolates were resistant to Penicillin followed by 39(75%) resistance to Clindamycin, 38(73.07%) to Erythromycin and 33(63.5%) to Chloramphenicol.
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Study of tibial ACL footprint in patients undergoing ACL reconstruction-correlation between pre-op MRI and intra-op measurements using arthroscopic ruler

TCMS-Special issue: Recent developments of medical and surgical research (2023), pp. 562 – 568 Open Access Full-Text PDF
Nandeesh S, Ambrish Sharma, Raju K P and Sumit Kumar

Abstract:Background: Currently measuring the preoperative size of the ACL tibial footprint. Length on sagittal MRI view is measured as the most anterior and most posterior portion of the ACL tibial attachment. To have an accurate measurement for the size of an ACL footprint, the ability to accurately identify the insertion site on MRI is important.
Methodology: 20 patients with ACL tear were included in the study.
Results: The mean age of the study participants was found to be 29.35+6.507 years. The mean weight of the study participants was found to be 75.55+12.84. The mean pre-op Tibial footprint of the study participants was found to be 12.54+2.24. The mean intra-op Tibial footprint of the study participants was found to be 12.87+1.53. The correlation was found to be statistically significant between the pre-op findings and the intra-op findings.
Conclusion: Tibial foot print length measured preoperatively on MRI can be used as a strong predictor for actual tibial length which can be helpful for prior planning of ACL reconstruction to improve the outcome.

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Awareness about HIV/AIDS amongst urban deaf adolescents and comparing it with normal adolescent population

TCMS-Special issue: Recent developments of medical and surgical research (2023), pp. 558 – 561 Open Access Full-Text PDF
Ashlesha Ashok Tawde and Prasad Waingankar

Abstract:Background: Among the greatest risk factors affecting deaf people is a general lack of knowledge about HIV/AIDS and its prevention. Studies found that deaf people are frequently unaware of or are misinformed about how AIDS is transmitted, how it can be prevented and who can get it.
Aims and Objectives: To study awareness about HIV/ AIDS amongst Urban deaf Adolescents and comparing it with normal Adolescent population.
Methodology: This was a cross-sectional study among the deaf adolescents and normal adolescents with respect to HIV/ AIDS amongst Urban population during the one month period i.e. March 2017. adolescents (10-19 Yrs.) students in the schools for Deaf selected randomly 100 and in the Normal adolescents students selected randomly 100 of a urban area were taken into the study. All the students with the written explained consent were undergone a semi-structured written questionnaire regarding the modes and prevention of HIV / AIDS was asked, there responses were noted, tabulated in the excel sheets and analyzed by SPSS 19 version software.
Result: The significantly lower awareness with respect to the modes of transmission like Mosquito bites (p<0.05), Sex in man to man (p<0.05), Kissing (p<0.05), Touching or hugging (p<0.05), Germs in the air (p<0.05), Unsterilized razors, HIV+ve mother to baby, Use of public toilets (p<0.05) respectively. There was significantly lower awareness regarding the prevention of HIV/AIDS was lower in Deaf adolescents e.g. Avoiding dirty places, Not hugging, Abstinence, Yoga and Meditation (p<0.05).
Conclusion: It can be concluded from our study that the deaf adolescent were significantly the knowledge and having misbelieves regarding HIV/ AIDS may be lack of education or lack communication and hence are at more risk of transmission than the general adolescent population.

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