Category Archives: TCMS – Vol 3 – Special Issue 2

Abstract:The World Health Organization (WHO) classified the most recent coronavirus disease outbreak of 2019 (COVID-19) a pandemic on March 11, 2020. The cause of COVID-19, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), largely affects the respiratory system, with viral pneumonia as a complication most common manifestation. Moreover, SARS-CoV-2 has a number of cardiovascular symptoms that raise COVID-19’s morbidity and fatality rates. Individuals are more likely to develop COVID-19 and have a worse prognosis if they have underlying cardiovascular illnesses and traditional cardiovascular risk factors. Endothelial dysfunction, widespread microangiopathy with thrombosis, and elevated angiotensin II levels are potential pathways of cardiovascular damage. Acute coronary syndrome, myocarditis, heart failure, cardiac arrhythmias, and sudden death can all be caused by myocardial hyperinflammation. The early stages of COVID-19 show a high level of cardiac troponins and natriuretic peptides, which indicates an acute myocardial damage. Given the intricate relationship between COVID-19 and cardiovascular symptoms, comprehensive knowledge for the proper management of these patients. Treatment is symptomatic until a particular antiviral medication for COVID-19 becomes available. Information about COVID-19’s cardiovascular risk factors and symptoms is provided in this review.

Abstract:Introduction: Stress among undergraduate students has become a significant concern in higher education due to its detrimental effects on their health and academic performance. This study aims to investigate the prevalence of stress among students pursuing their undergraduate education in a college in Kerala. By exploring the association between various sociodemographic variables and stress levels and identifying the relationship between different risk factors and stress, this research aims to provide valuable insights into the factors contributing to stress among undergraduate students.
Materials and Methods: A cross-sectional study was conducted among 133 undergraduate students. Convenience sampling was utilized to select the participants. A pre-designed closed-ended questionnaire, specifically tailored for this study, was employed to collect data. The questionnaire consisted of relevant items related to stress experienced by undergraduate students. Appropriate statistical analyses were performed on the collected data, with a significance level set at p < 0.05.
Results: The findings of this study revealed that among the study participants, 19% of undergraduate students experienced high perceived stress, 67% experienced moderate stress, and 13% experienced low-stress levels. A statistically significant association was observed between reduced appetite and perceived stress (p-value = 0.014). Additionally, statistically significant associations were found between stress and poor relationships with faculties (p-value = 0.003), the warden (p-value = 0.01), family members (p-value = 0.003), facing time pressure (p-value = 0.006), heavy workloads (p-value = 0.029), fear of failure (p-value = 0.002), suffering from frequent exams (p-value = 0.003), and exam patterns and curriculum (p-value = 0.024).
Conclusion: The results of this study highlight the considerable prevalence of stress among undergraduate students, with the majority falling into the category of moderate stress levels. It is imperative to prioritize undergraduate students’ mental and physical well-being by incorporating counseling services and preventive mental health programs as integral components of routine clinical services. Encouraging students to engage in regular physical exercise, maintain balanced nutrition, foster positive relationships with peers, family, faculty, and college staff, ensure adequate sleep, and participate in extracurricular activities can significantly reduce stress levels. By addressing these factors, educational institutions can foster a supportive learning environment that promotes undergraduate students’ overall health and well-being.

Abstract:Objective: To evaluate the demographic data such as age, parity, living male child, educational status, intraoperative, and postoperative complications of laparoscopic tubal ligation by single puncture method.
Methods: A prospective study of Laparoscopic Tubal Ligation was conducted at a medical college during 2016-2022. A total of 1060 cases were enrolled based on criteria, and Laparoscopic Tubal Ligation was performed under sedation plus local anesthesia. The procedure was done after 1st trimester MTP, during the interval, and the puerperal period.
Result: Most of the patients (79.67%) were in the age group of 22-30 years. 53.38% were para 2. Out of the total, 97.24% of women had 2 or more living children, while only 2.76% had only one living child. Similarly, 97.24% had 1 or more male child, and only 2.76% had no male child. During the procedure, 3 (0.28%) patients had uterine perforation, and one (0.9%) had Mesosalpinx hematoma that required laparotomy. Additionally, 3 (0.28%) patients had serous and blood discharge from the wound, 4 (0.37%) had wound gaping, and 1 (0.9%) had omental prolapse. None of the patients developed peritonitis, bowel injury, or required laparotomy at a later stage. Further study and follow-up are required to comment on the failure rates.
Conclusion: The associated factors with single puncture laparoscopic tubal ligation include age, parity, number of living children, male child, complications, and timing of surgery.

Abstract:Introduction: Since December 31st, 2019, SARS-CoV-2 infection (COVID-19) has affected individuals in various ways. During this pandemic, a notable increase in patients presenting with symptoms such as frequency, urgency, burning sensation, hematuria, fever with chills, with or without minimal Influenza-like Illness (ILI), who later tested positive for COVID-19, has been observed. Hemorrhagic cystitis is the most common presenting symptom of viral urinary tract infection (UTI), and some COVID-19 survivors have presented with recurrent hemorrhagic cystitis. These observations prompted us to evaluate the risk factors and association of hemorrhagic cystitis with COVID-19 patients.
Methods: A prospective observational study was conducted among patients presenting with symptoms of cystitis in an outpatient department.
Results: Socio-demographic and clinical characteristics, laboratory and radiological findings were collected, compiled, and analyzed using SPSS ver. 17.0. Out of 152 patients with cystitis, 96 had ILI and subsequently tested positive for COVID-19, and 20 had recovered from COVID-19 in the past month. Hematuria was found as the presenting symptom in 90 (59.21%) patients, with 78 (86.67%) testing positive for COVID-19 and 12 (13.33%) testing negative. According to the Droller et al. grading system, 49% had grade 1 severity, and 32% had grade 2 severity. Diabetes was the most significant risk factor associated with hemorrhagic cystitis.
Conclusion: This study clearly demonstrates an increased prevalence of and association with hemorrhagic cystitis in COVID-19 patients in this tertiary care center. Therefore, routine investigations in SARS-CoV-2 infected cases, such as urine cytology, upper tract imaging, and cystoscopy, will aid in the early diagnosis and proactive management of COVID-19-associated cystitis.

Abstract:Background: Irrational prescribing practices have a negative impact on the health and economy of individuals and society as a whole, resulting in resource wastage and widespread health hazards. The aim of this study was to analyze the drug prescribing pattern in patients with Chronic Obstructive Pulmonary Disease (COPD).
Methods: This prospective study included outpatients with COPD. Various parameters were recorded, including patient age, gender, outpatient ID number, occupation, smoking history, alcohol consumption, disease condition details, co-existing diseases, and prescribed medication details. The drug selection was assessed based on the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines. Data was collected using a specially designed data entry form and tabulated. The results were expressed as percentages.
Results: The prescription data of 72 patients were analyzed in this study, comprising 58 males (80.56%) and 14 females (19.44%), with a mean age of 55.95 years. The male-to-female ratio was 4.14:1. Out of the total 72 patients, 62 (86.11%) were smokers, with 25 (40.32%) currently smoking and 37 (59.68%) being ex-smokers. Hypertension was the most common comorbidity, present in 35 (48.61%) patients. Inhalation was the most common route of drug administration in the study, followed by the oral route. The most frequently prescribed drugs were Formoterol (LABA) in 58 (81.56%) patients, Budesonide in 54 (75%), Acebrophylline in 44 (61.11%), while Terbutaline was the least used in 7 (9.72%) patients and Methylprednisolone in 6 (8.33%) patients.
Conclusion: The data revealed a low utilization of monotherapies, specifically long-acting muscarinic antagonist (LAMA), and a high utilization of combination therapies, particularly those containing inhaled corticosteroids (ICS). The drug prescribing pattern analysis aims to provide feedback and create awareness about appropriate medicine use.

Abstract:Background: Osteoarthritis (OA) is a chronic degenerative disorder that affects the joints, causing pain and stiffness. Its prevalence in India ranges from 22% to 39%. Considering the increasing life span and the burden it imposes on individuals and society, early detection or prediction of OA in high-risk groups is crucial for implementing preventive measures. Several risk factors, including weight, genetic factors, sex, previous traumas, occupational factors, physical activity, lifestyle, and age, are associated with osteoarthritis. The geometry of the articular surface may also play a significant role, especially in the sagittal plane. The posterior tibial slope (PTS), defined as the posterior inclination of the tibial plateau in relation to its longitudinal axis in the lateral view, is a determinant of altered joint biomechanics. However, there is a lack of studies examining the correlation between the PTS angle and the risk of knee osteoarthritis in the Indian population. This study aims to determine the value of, and confirm the association between changes in posterior tibial slope observed on radiographs and osteoarthritis.
Materials and Methods: After obtaining ethical approval, 153 individuals visiting the outpatient department were selected based on inclusion and exclusion criteria. Demographic parameters such as age, sex, weight, height, co-morbidities, and medications were recorded. Knee examination findings, pain assessment using the Visual Analog Scale (VAS), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were documented. Knee joint radiographs, including anteroposterior (AP) and lateral views, were examined for patients with early OA (Kellgren-Lawrence Grade I and II). The posterior tibial slope was measured by determining the angle between the tangent to the tibial plateau and the perpendicular direction to the Tibial Shaft Anatomical Axis (TSAA).
Results: The study included 153 individuals with early osteoarthritic knees (Grade I and II). The mean posterior tibial slope measured in our study was found to be 11.5 with a standard deviation of 1.34. The range of PTS in our study was between 7\(^o\) and 13\(^o\).
Conclusion: Our study reveals that the posterior tibial slope in patients with early osteoarthritis was higher compared to the known normal values in the Indian population, suggesting an increased posterior tibial slope in individuals with osteoarthritic degeneration. Therefore, the posterior tibial slope can be used as a marker for screening osteoarthritis and initiating appropriate early interventions.

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.