Category Archives: TCMS – Vol 3 – Special Issue 2

Abstract:Background: Orthopaedic surgeries of lower limb are well suited for central neuraxial blockade. While the surgeries are done under spinal anesthesia, demand for post operative pain relief and need to reduce the use of systemic analgesics requires epidural analgesia in the post-operative period.
Objective: To evaluate and compare the duration of analgesia of 0.375% Ropivacaine and 0.25% Levobupivacaine given by epidural routes in lower limb orthopaedic surgeries in 24 hrs post operative period.
Material and Methods: In this prospective, randomized, double blinded clinical study, 60 adult patients of ASA I-II of both sexes were randomized into 2 groups(n=30). Patients received 7ml of 0.375% Ropivacaine in group R and 7ml of 0.25% Levobupivacaine in group L through epidural catheter.
Results: There was no significant difference between two groups with respect to demographic profile and ASA physical status. The mean duration (minutes) of analgesia after each epidural topup was significantly longer in group L (303.5\(\pm\)21.8) compared to group R (273.2\(\pm\)23.42) with p value 0.001. Total number of epidural topups were 5 for both the groups, rescue analgesics were needed in only 2 patients in each group. Quality of motor block was predominantly grade 0 of modified bromage scale in more than 80% patients in both the groups. Haemodynamic stability was well maintained and no adverse effects encountered in both the groups.
Conclusion: Epidural 0.25% Levobupivacaine and 0.375% Ropivacaine in their equipotent doses provided adequate post operative analgesia for lower limb orthopaedic surgeries. Levobupivacaine provided prolonged duration of analgesia compared to ropivacaine. But the total number of epidural topups, need for rescue analgesics and quality of motor block were similar for both the study drugs without any haemodynamic variations and adverse effects.

Abstract:Background: Dengue is an endemic disease in tropical and subtropical regions of the world causing severe epidemic in India and is endemic in many parts of India, especially in metropolitan cities and towns. There are evidences which states that platelet parameters may have diagnostic and prognostic value in febrile thrombocytopenia including Platelet count, Mean platelet volume (MPV), Platelet distribution width (PDW), Plateletcrit (PCT). These parameters are obtained as a part of Complete Blood Count using Automated Hematology analyzers.
Aim and Objectives: of this prospective study is 1) To evaluate the role platelet parameters in Dengue fever and also to determine the relationship of platelet parameters with platelet count and disease severity. 2) to assess the utility of platelet profile in patients with Dengue fever and understand its significance so that adverse outcomes of this rapidly spreading disease can be controlled to a greater extent.
Material and Methods: This study was conducted on 133 confirmed cases of Dengue infected patients for a period of 9 months from April 2022 to December 2022. The Platelet parameters like Platelet count, MPV, PDW and Plateletcrit were measured by using BC 300 plus Mindray Automated Hematology Analyzer on venous samples collected in K3EDTA from 133 patients and was compared with disease severity (DF/DHF/DSS) . These 133 patients were grouped into three according to platelet count (<20000, 20000-100000, >100000).
Results: Out of 133 patients, 17 patients who had platelet count <20000, the Mean MPV, PDW and PCT was 9.2 fl, 17.3 fl and 0.03% respectively, 86 patients who had platelet count between 20000-100000 the mean MPV, PDW and PCT was 12.2fl, 16.6fl and 0.1% respectively, 30 patients who had platelet count more than 1 Lakh, the mean MPV, PDW and PCT was13.7fl, 13.8 fl and 0.1% respectively which showed statistically significant difference between the groups (p value 0.003).
Conclusion: The study focuses on the importance of platelet parameters in patients with Dengue infection. Significant differences were observed in MPV, PDW and PCT in patients with dengue infection. Low platelet count, low MPV, high PDW and low PCT shows sensitivity for DF thus reflecting a predictive marker for diagnosing DF in endemic area.

Abstract:Due to the lack of effective therapies, therapeutic care such as medicines and early hemodialysis is viewed as the major kind of supportive care for paraquat poisoning. The aim of our present study was to evaluate acute kidney injury and its impact on various clinical parameters, including length of hospital stay, episodes of hemodialysis, number of ICU admissions, and mortality rates. This prospective observational study was launched after receiving approval from the Institutional Ethics Committee. All patients with acute renal injury caused by paraquat were admitted to the ward of the Department of General Medicine, VIMSAR, Burla, and included in the present study after obtaining informed written consent from each participant. The results showed that serum phosphorus and uric acid were highly significant (P < 0.001) when compared to laboratory features based on clinical outcomes, followed by alanine aminotransferase (ALP; P = 0.006), serum bicarbonate (P = 0.007), and serum potassium (P = 0.009). In conclusion, paraquat poisoning has no cure, but clinicians can monitor vital statistics and laboratory changes from diagnosis onward to understand the disease's trajectory. It is recommended that the government prohibit the widespread distribution of this pesticide and inform the public about its toxicity.

Abstract:Background and Aim: Sepsis is a commonest cause of morbidity and mortality in the newborns and probably accounts for 30 to 50 percentage of neonatal death worldwide in developing countries so the study aimed to find out the most reliable laboratory parameter in early diagnosis of neonatal sepsis in comparison with blood culture in terms of Sensitivity, Specificity, Positive predictive value, Negative predictive value.
Material and Methods: A cross sectional study was conducted in the NICU and SCNU at Institute of Child Health, Government Medical College, Kottayam to evaluate the laboratory markers like total WBC count, I-T ratio, CRP, platelet count in early diagnosis of neonatal sepsis in comparison with blood culture. After taking informed consent from parents and permission from ethical committee, neonates brought to neonatology unit were selected by purposive sampling technique. Sample size was 120. All neonates having suspected sepsis were included. All neonates included in the study were started on empirical antibiotics after drawing samples for blood cultures, total WBC count, I-T.
Results: This study was designed to find out the most reliable parameter in early diagnosis of neonatal sepsis like total count, CRP, I-T ratio and platelet count in comparison with blood culture in terms of sensitivity, specificity, PPV and NPV.A total of 120 babies were studied who satisfied the inclusion criteria and ruling out those meeting exclusion criteria. Out of 120 babies studied early onset sepsis include 52.5% and late onset of sepsis include 47.5%.
Conclusion: This study proves that CRP is a test with good sensitivity and I-T ratio with maximum specificity but least sensitivity. These can be used for diagnosis of neonatal sepsis and treatment can be initiated before the blood culture results come.

Abstract:Intrathecal bupivacaine results in a longer duration of complete anaesthetic block than ropivacaine. Fentanyl used as an adjuvant may improve the quality of spinal block of ropivacaine, while maintaining its advantage of early motor recovery. The aim of the study was to compare the efficacy and safety of intrathecal ropivacaine-fentanyl (RF) with bupivacaine-fentanyl (BF) for lower limb orthopaedic surgeries. In this Single Centered, Prospective, Randomized, Parallel group, Double-Blind study, sixty patients were randomly allocated to receive either intrathecal 15 mg of 0.5% ropivacaine with 25 mcg fentanyl (Group RF) or 15 mg of 0.5% bupivacaine with 25 mcg fentanyl (Group BF). The onset, duration, spread of sensory and motor block, hemodynamic parameters, and side effects were recorded. Data analysis was done using SPSS software and Sigma Stat 3.5 version (2012). The time to reach the highest sensory level, complete motor block, and two-segment sensory regression time were comparable between the two groups. The motor recovery to Bromage scale 1 was faster in Group RF. The hemodynamic stability was better in Group RF. However, the time duration of analgesia was prolonged in Group BF. Intrathecal RF provided satisfactory anesthesia with hemodynamic stability for lower limb orthopaedic surgeries. It provided a similar sensory but a shorter duration of motor block compared to BF, which is a desirable feature for early ambulation, voiding, and physiotherapy.

Abstract:Background: Primary angle closure glaucoma (PACG) contributes considerably to the global burden of visual impairment.
Objective: To prospectively evaluate changes in anterior chamber width after laser iridotomy in primary angle closure suspect using GONIOSCOPY and BIOMETRY.
Material and Methods: This was a prospective non-randomized interventional hospital based study. 50 eyes of 29 patients with primary angle closure suspects (PACS) requiring Laser Peripheral iridotomy were included in the study.
Results: The study showed a statistically significant change between pre PI and post PI peripheral anterior chamber depth(PACD) 1.1\(\pm\)0.4 Vs 2.70\(\pm\)0.8(P<0.05) Statistically significant change in gonioscopic grading between pre and post PI, superior (0.20\(\pm\)0.40Vs2.20\(\pm\)1.10), inferior (1.0\(\pm\)1.0Vs.2.50\(\pm\)0.90), nasal (0.3\(\pm\)0.6Vs.2.40\(\pm\)0.90), and temporal quadrant (0.4\(\pm\)0.8 Vs. 2.30\(\pm\)1.0) (P<0.05). There was an overall increase of 2 units in Shaffer angle grading in all 4 quadrants. There was a significant decrease in IOP post iridotomy (16.44\(\pm\)2.70mmHg Vs 14.18\(\pm\)2.62mmHg),(P<0.05), almost 2mmHg of fall in IOP. The study showed statistically no significant change between pre and post PI biometry values-AXL and ACD.
Conclusion: Laser iridotomy produced a significant widening of the anterior chamber angle in patients with primary angle closure suspects as studied by gonioscopy and biometry. Gonioscopy is a viable tool to assess the effect of laser iridotomy.

Abstract:Background: Angular deformities of knee in children are a commonly encountered condition in orthopedic practice. Many of the cases are physiological and do not warrant any treatment.
Aim:To assess the functional and anatomical outcome of 8-plate fixation for genu valgum or genu varum deformities in children.
Material and Methods: The study was designed as a prospective and retrospective hospital based study in Dept. of Orthopedics, Govt. Medical College, Kozhikode. Patients attending the Orthopedic outpatient department at Govt. Medical College, Kozhikode between 1/6/2017 to 31/3/2019. Sample size was found to be 24. SPSS was used for analysis.
Results: Out of the 24 cases, 3 were implanted at age < 10 years. Median age at intervention was 13 years. Average age at intervention was 12.25 with a range of 9 years to 14 years. The following results were observed after following up a total of 24 patients who has undergone 8-plate fixation for angular deformities of knee. 15 were boys and 9 were girls. 18 were having valgus deformity and 6 were having varus deformity. In total 39 limbs and 56 physis were intervened. Mean period for implant removal is more when only tibia is implanted and least when both tibia and femur are implanted. However, this can’t be used to compare the efficacy of different implanting sites, as removal of implant is influenced by several factors like follow up visits and severity of primary deformity. More reliable measurement is the rate of correction of deformity.
Conclusion: In our study, we were able to demonstrate that hemiepiphysiodesis using eight plate is an effective and safe treatment for angular deformities of knee in children irrespective of the age group, sex and primary deformity. The rate of correction of deformity decreases as the age increases. So, early surgery is advisable in diagnosed pathological deformities. A proper follow up of the treated patients is needed to assess the response.

Abstract:Introduction: Three instances of the HBs’ encapsulation with a nodular, grey-white exterior surface were noted. The sliced surface was feshy, tan to grey-white, and there were patches of necrosis and haemorrhage.
Material and Methods: Names, ages, genders, and other information were recorded. Alpha fetoprotein levels (APLs), complete blood counts, liver function tests, and other laboratory data were noted. Contrast computed tomography was used to assign PRETEXT staging (CT).
Results: Patients frequently reported vomiting in 25 cases, 43 cases of abdominal distension, 21 cases of jaundice, and 19 cases of an abdomen mass. The distinction was noteworthy (P 0.05).
Conclusion: Researchers discovered that the majority of cases were epithelial as opposed to mixed epithelial and mesenchymal, and that women predominated.

Abstract:Background: Otitis media (OM), a common ear infection, affects children. Most pediatric medical appointments are for otitis media. Otitis media (OM) is the major cause of permanent hearing loss. OM has three primary subtypes: acute, OM with effusion, and chronic suppurative OM (CSOM).
Material and Methods: This study is a meta-analysis on the link between air pollution and middle ear infections in Indian children. The PRISMA (Preferred Reporting Items for Systematic reviews and Meta-analyses) guidelines for reporting systematic reviews and meta-analyses were followed throughout this investigation. This study was about otitis media, which is also called glue ear, middle ear infection, OM, AOM, OME, CSOM, or middle ear infection. It is important because it affects so many people. We were exposed to air pollution from both inside (from heating and cooking) and outside (from cars and trucks) sources (from factories or cars).
Results: 1246 references were taken out because there were fewer of them. After the first round of evaluation, 661 out of the 743 citations were found to be unnecessary. The full texts of 82 publications were looked at to see if they could be included. There was a total of eleven investigations: three in the US, two in Canada, and one in the both Netherland and Germany, the other studies were conducted in Italy, Czech Republic, South Korea, China and Spain.
Conclusion: This comprehensive review found that air pollution increases the risk of OM in babies and children. Exposure to higher amounts of NO2, PM, SO2, PAH, and wood smoke increases OM infections, however the extent is unclear. PM10, NO2, O3, SO2, and CO enhanced OM risk immediately and for 1-4 weeks.

Abstract:Background: The present study was performed to determine and compare the analgesic effect of dexamethasone as an adjuvant to caudal block when given intravenously and caudally.
Material and Methods: This interventional, double-blinded, randomized controlled study included 165 pediatric patients aged 1-5 years with anaesthesiology (ASA) physical status I and II admitted to the hospital for elective infraumbilical surgeries. Children were allocated randomly with the chit method to three groups such that subjects in group I received caudal Bupivacaine 0.25% (1ml/kg), along with caudal normal saline (NS) 0.025ml/kg and IV NS 0.075ml/kg; group II received caudal Bupivacaine 0.25% (1ml/kg) with caudal dexamethasone 0.1 mg/Kg (0.025ml/kg) and IV NS 0.075ml/kg; group III received caudal Bupivacaine 0.25% (1ml/kg) along with caudal NS 0.025ml/kg and IV dexamethasone 0.3mg/kg (0.075ml/kg) (dexamethasone sodium phosphate vial 4mg/ml). Patients-intraoperative hemodynamic parameters were recorded every 10 minutes till the end of surgery. Postoperative pain was assessed hourly with a FLACC score until the score was>3, and the time was noted as analgesia duration. Total analgesic consumption during the first 24 hours was also noted down.
Results: In Group 1, the mean time to first rescue analgesia was 4.00\(\pm\)0.69 hours; in Group 2, it was 8.07\(\pm\)0.57 hours and in Group 3, it was 5.51\(\pm\)0.50 hours (p value<.05). In Group 1, mean total analgesic consumed in first 24 hours was 666.09\(\pm\)174.69 mg, in Group 2, it was 200.09\(\pm\)66.42 mg and in Group 3, it was 384.55\(\pm\)135.04 mg (p value<.05).
Conclusion: Dexamethasone as an adjunct to caudal Bupivacaine 0.25% (1ml/kg) provides effective postoperative analgesia.