Quality improvement project for the prevention of VAP using bundle care approach in tertiary care hospital

TCMS-Special issue: Recent developments of medical and surgical research (2023), pp. 486 – 494 Open Access Full-Text PDF
Venugopal K, Madhu G, Thirumaleshwara M and Girish P

Abstract:Background and Aims: Ventilator associated pneumonia (VAP) develops after more than 48 hours of mechanical ventilation. VAP is the leading cause of death among hospital acquired infection and prolongs time spent on the ventilator, length of intensive care unit (ICU) stay and length of hospital stay after discharge from the ICU. The concept of ‘bundles’ which can be defined as groups of evidence based interventions when, performed together, improve outcome. Hence this study was undertaken to assess the incidence of VAP and effectiveness of Bundle to prevent VAP.
Methods: This study was conducted in two phases. Pre-interventional phase (Phase-1) is done for three months by observing the current practices in mechanically ventilated patents and assessing the incidence of VAP. Then in post-interventional phase is conducted for three months by applying the bundle care approach, educating the interns, staff nurses and contact care givers regarding the quality improvement project and then assessing the incidence of VAP.
Results: Total 40 patients were involved in the study with 20 patients in each trial. The incidence of VAP was more in pre-interventional trial and the VAP incidence was reduced in post-interventional trial after implementing bundle care.
Conclusions: VAP prevention can be achieved to a large extent with the use of Bundle care approach .However, a major limitation is the lack of adherence to the set protocols by the health care professional especially in developing countries like India where the still the Patient to Nurse ratio is poor and overworked doctors . But one of the way to improve is by educating them through targeted training and using checklist which will help to improve adherence and ultimately patient outcome.

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A comparative study on the effectiveness of platelet rich plasma injection versus corticosteroid injection in treatment of adhesive capsulitis of shoulder

TCMS-Special issue: Recent developments of medical and surgical research (2023), pp. 476 – 485 Open Access Full-Text PDF
Pinnaka Vijaya Shankar, Thati Bharath, Sunkara Rajesh and Rangu Aswini

Abstract:Objective: The objective of this study was to compare the effects of single intra-articular platelet-rich plasma (PRP) and corticosteroid (CS) injections in patients diagnosed with adhesive capsulitis of the shoulder.
Design: Patients between the ages of 30-70 years, of either sex, diagnosed with adhesive capsulitis of the shoulder with a duration of less than 6 months, were included. In the intra-articular corticosteroid (IA-CS, control) group, 30 patients received a single injection of IA-CS (2 ml), while in the IA-PRP (test) group, 30 patients received a single IA-PRP injection (2 ml) into the glenohumeral joint under ultrasound guidance. All patients were prospectively followed for 24 weeks.
Results: Thirty patients in the IA-PRP group and thirty in the IA-CS group completed the entire 24-week study period. At 24 weeks, a decrease in QUICK DASH score was observed in the IA-PRP group (16) compared to the IA-CS group (33). In terms of range of movement, the IA-PRP group showed significant improvement in abduction, internal rotation, and external rotation compared to the IA-CS group. No major complications were observed in any patients.
Conclusions: At the 24-week follow-up, a single dose of IA-PRP injection was found to be more effective than an IA-CS injection in improving pain, disability, and shoulder range of motion in patients with adhesive capsulitis of the shoulder.

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Immunohistochemical expression of AE1, AE3 on cell blocks of metastatic lymphnodes

TCMS-Special issue: Recent developments of medical and surgical research (2023), pp. 470 – 475 Open Access Full-Text PDF
Shamili Moningi, Sireesha Gunta, Kalyani Sharmila, I. Vijaya Bharathi and T. Kishorekumar

Abstract:Overview: Cancer poses a significant global threat\({}^{1}\). Lymph nodal metastasis is a crucial prognostic factor, and its detection presents a challenge for pathologists.
Aims: The aims of this study are as follows: to determine the common sites affected by metastatic lymphadenopathy, to evaluate the effectiveness of the cell block technique in preserving cell morphology compared to conventional fine needle aspiration (FNA) samples, to assess the preservation of immunohistochemical properties using the cell block technique, and to determine the role of immunohistochemistry in cell block preparations of malignant breast neoplasms for making a final diagnosis.\\
Materials and Methods: Immunohistochemistry using AE1 and AE3 markers was performed on sections made from cell blocks obtained through the fine needle aspiration technique. Cell block preparation involved a mixture of 9 parts ethyl alcohol and 1 part 10% formalin, followed by hematoxylin and eosin staining. Two pathologists independently analyzed H&E-stained smears and immunocytochemistry results, and the findings were calculated.
Results: In the present study, pan CK positivity was observed in 31 out of 48 cases, of which 25 were squamous cell carcinomas, 2 were suspicious for malignancy, and 2 were other cases.
Conclusion: The use of Pan CK (AE1/AE3) markers demonstrated a significant percentage of positivity in identifying squamous differentiation. This panel of markers, along with others, can be employed for epithelial differentiation and can assist in neoadjuvant therapy and patient care.

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To study the levels of cytokines in metabolic syndrome and non-metabolic syndrome individuals

ODAM-Special issue: Indian Medical Research Views and Findings on Last 5 years (2023), pp. 250 – 254 Open Access Full-Text PDF
Abdul Rab Alli, Dr. Shreya Nigoskar and Doddigarla Zephy

Abstract:Background: Metabolic syndrome is characterized by abnormalities in blood pressure, blood sugar, waist circumference, and cholesterol or triglyceride levels.
Aim: The unique aspect of this study is its primary focus on determining whether there is a distinction in inflammatory markers between individuals with metabolic syndrome and those without the condition.
Material and Methods: The study included 50 patients with metabolic syndrome and 50 healthy controls. The research was conducted at Indore Index Medical College & Research Centre. After obtaining approval, the study’s researchers commenced their work. Each subject provided informed consent prior to the study. Individuals with type 1 diabetes or clinical symptoms for fewer than five years and documented T2DM duration were excluded. Healthy controls (non-metabolic syndrome) were individuals without diabetes, multivitamin use, or comorbidities.
Statistical analysis: Regressions were used to determine the relationship between two variables. Additionally, percentages were calculated. A significance level of \(p < 0.05\) was considered significant.
Conclusion: The significance of these results cannot be overstated. The study’s findings unequivocally demonstrate that both pro-inflammatory and anti-inflammatory cytokines contribute to the development of secondary illnesses associated with metabolic syndrome.

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Analysis of gastric strictures presentation and their surgical management outcome

ODAM-Special issue: Indian Medical Research Views and Findings on Last 5 years (2023), pp. 245 – 249 Open Access Full-Text PDF
Dr. Kunal Chinubhai Modi, Dr. Mehulkumar K Vasaiya, Dr. Khyati Shah and Dr. Pranav Rambhai Patel

Abstract:Background and Aim: Corrosive gastric strictures may require more frequent dilations compared to peptic ulcer-related strictures. Strictures occurring at the distal gastric site may necessitate sufficient dilatation to prevent obstructive symptoms, but this comes with an increased risk of perforation. The aim of the study was to determine the mean duration between corrosive consumption and the development of gastric stricture.
Material and Methods: The present study analyzed data collected from patients admitted to the surgical unit of Medical College & associated hospital following corrosive ingestion. Clinical data, including a history of difficulty in swallowing, cough with expectoration, difficulty in breathing, abdominal pain, abdominal distension, vomiting, and fever, were collected. Barium swallows were performed to assess and locate the stricture site in the stomach and assess the distal flow. Intraoperative findings of corrosive strictures and the nature of the performed surgery were analyzed. Barium meal studies were conducted for all patients to locate the level of stricture in the stomach, identify associated esophageal strictures, and detect coexisting trachea-esophageal fistulas.
Results: A total of 24 patients who met the inclusion and exclusion criteria were included in the study. Among the 24 patients, 6 had hyponatremia, 5 had type I strictures, 3 had type VII strictures, and 2 had type IV strictures with hyponatremia. Type I strictures were observed in 4 patients, 1 patient had type VII, and 1 patient each had other types of strictures with hypokalemia. Hypokalemia was present in 8 patients with type I strictures, 3 with type VII, and 1 each with type IIa, type IIb, type III, and type IV strictures. Arcade-preserving antrectomy was performed in 6 patients. One patient had type IIa corrosive gastric stricture and was managed with stricturoplasty. Two patients with type IIb corrosive gastric strictures were treated with Pylorus Preserving Antrectomy. Two patients had type III corrosive gastric strictures, and they underwent circumferential sleeve resection and gastro-gastrostomy.
Conclusion: Adequate preoperative nutritional optimization and evaluation to assess the extent of injury can significantly reduce the morbidity and mortality associated with gastric corrosive strictures.

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Prevalence of vitamin D deficiency in east nimar region: An observational study

ODAM-Special issue: Indian Medical Research Views and Findings on Last 5 years (2023), pp. 241 – 244 Open Access Full-Text PDF
Dr. Harshul Patidar, Dr. Priyesh Marskole, Dr. Nisha Kaithwas, Dr. Sachin Parmar and Dr. Ranjeet Badole

Abstract:Vitamin D is a crucial fat-soluble vitamin with various functions. Its deficiency is widespread and affects individuals of all age groups. This study aimed to determine the prevalence of Vitamin D deficiency in different age groups and genders within the East Nimar region. A total of 236 participants were included, and their Vitamin D levels were measured using a Mindray CL-900i Chemiluminescence Immunoassay Analyzer. The results were stratified by age groups and gender. Among the 236 individuals, 47.9% were males and 52.1% were females. The study revealed that 86.4% of the subjects had insufficient or deficient levels of Vitamin D, while only 13.6% had sufficient levels. Specifically, 33.5% of the cases had Vitamin D deficiency, and 57.2% had Vitamin D insufficiency. Vitamin D deficiency was observed in 51.80% of individuals with higher sun exposure and 75% of those with lower exposure. Among supplement users, 45.2% had Vitamin D deficiency, whereas among non-users, the rate was 69.58%. The findings underscore the high prevalence of Vitamin D deficiency in India. Considering the inadequate dietary intake of Vitamin D in the Indian population, measures such as food fortification, Vitamin D supplementation, and exposure to sunlight (especially in the morning) are crucial to address this issue and prevent the complications associated with Vitamin D deficiency.

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Thyroid volume and its correlation with thyroid function in central India

TCMS-Vol. 3 (2023), Issue 2, pp. 15 – 23 Open Access Full-Text PDF
Dr. Alka Agrawal, Dr. Gaurav Bhandari, Dr. Ashish Sahoo, Dr. Mohd. Asif and Dr. Mengpi Jamoh

Abstract:Introduction: Thyroid gland volume is highly variable as it is greatly influenced by age, gender, anthropometric measurements, and geographical location. It has become essential for every population to determine the reference range of their normal thyroid gland volume in healthy individuals. This, in turn, will help the population in grading goitre and guide large-scale iodine monitoring programs. Ultrasound, being more precise than clinical examination in identifying enlarged thyroid glands, overcomes the problems of overestimation of goitre prevalence and marked interobserver variability associated with palpation estimates. A nomogram of thyroid volume in our environment is important to serve as a reference point in managing patients with thyroid pathologies, especially goitre. The purpose of this study was to establish reference ranges of total thyroid volume among the normal adult population in central India using ultrasonography and correlate it with thyroid function tests.
Methods and Material: A prospective cross-sectional study was conducted in a tertiary care hospital. A total of 410 healthy subjects were included. B-mode Ultrasonography was used to measure the total thyroid volume by combining the volume of both lobes obtained using the ellipsoid formula. Blood samples were taken for thyroid function tests. Age-specific reference values for thyroid volume were obtained.
Statistical analysis used: IBM Statistical Package for the Social Sciences (SPSS) software for Windows, Version 26.0. Armonk, NY: IBM Corp was used for analysis.
Results: The mean total thyroid gland volume of all study subjects was \(6.90\pm1.74\) ml. Males had a significantly higher gland volume (\(7.30\pm1.86\) ml) compared to females (\(6.63\pm1.61\) ml) (\(P<0.001\)). The volume of the right lobe was significantly greater than that of the left lobe in both genders (\(3.76\pm0.96\) ml vs \(3.14\pm0.89\) ml, \(P<0.001\)). No significant correlation was found between gland volume and thyroid function tests.
Conclusions: We attempted to contribute to establishing the reference values for our local population, and further large studies are required to establish nationwide reference values of thyroid gland volume.

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Cytomorphological changes in buccal mucosa cells and to establish correlation with the morphometric analysis of opening of mouth among smokers and non-smokers: A comparative study

TCMS-Vol. 3 (2023), Issue 2, pp. 7 – 14 Open Access Full-Text PDF
Pankaj Chourasiya, Dr. Pawan Kumar Mahato, Dileep kumar Padmakaran and Judith Jaison

Abstract:Background: Smoking is currently the most preventable cause of diseases and death worldwide and is one of the causative risk factors for developing cancer in different organs. Therefore, smoking patients must be carefully monitored for alterations in buccal mucosa caused by tobacco abuse.
Aim and Objective: The aim of the study is to investigate cytological changes in buccal mucosa cells and establish a correlation with the morphometric analysis of mouth opening among smokers and non-smokers.
Materials and Methods: A comparative study was conducted on 200 individuals aged between 20 and 60 years. The subjects were randomly chosen from inpatients and outpatients of the Medicine Department at Index Medical College and Hospital. Buccal smears of these patients were processed in the Department of Anatomy.
Results: Significant differences were observed between non-smokers and smokers for cells with binucleation, pyknosis, perinuclear halo, cytoplasmic granules, karyolysis, karyorrhexis, and micronuclei in buccal mucosal cells. However, no significant difference was found for cytoplasmic vacuoles between non-smokers and smokers. Similar studies have reported findings consistent with our non-smoking population.
Conclusion: The present study indicates that almost all cytomorphological findings were higher in smokers than in non-smokers. Early detection of oral cancers becomes complex as they are mostly innocuous and asymptomatic during their initial stages. Cytomorphometric analysis can be used regularly to detect these cell alterations.

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Review of management of refractory constipation: What lies ahead

TCMS-Vol. 3 (2023), Issue 2, pp. 1 – 6 Open Access Full-Text PDF
Dr. Dinesh Banur Onkarappa, Dr. Vidya Puttagunta and Dr. Swapna Rani Bade

Abstract:Childhood constipation is a prevalent issue globally. Certain children experience persistent constipation and soiling, either as a result of surgical repair of anorectal malformations or underlying medical conditions that present management challenges. These refractory cases of constipation significantly affect the psychological well-being of both patients and their families. The available treatment options for refractory constipation are not clearly established. However, prompt and appropriate management of constipation contributes to an enhanced health-related quality of life. This article explores the current modalities available for treating children with challenging constipation and examines their impact on health-related quality of life.

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Comparison clinical efficacy of dexmedetomidine and magnesium sulphate as an adjuvant to bupivacaine for transverse abdominis plane block in caesarian section for post operative analgesia

ODAM-Special issue: Indian Medical Research Views and Findings on Last 5 years (2023), pp. 234 – 240 Open Access Full-Text PDF
Dr. Basant Kumar Ningawal, Dr. Seema Bamania, Dr. Gaurav Songara, Dr. Neha Merawi and Dr. K. K. Arora

Abstract:Background: The Transversus Abdominis Plane (TAP) Block is a method used for regional anaesthesia. It offers analgesia during lower abdominal surgery, especially when parietal wall pain is a significant source of discomfort. Through the local anaesthetic deposition between the Transversus Abdominis muscle and internal oblique muscle, it permits sensory blockage of the lower abdominal wall’s skin and muscles. In a hospital-based, prospective observational study we assessed the effectiveness of unilateral TAP Block with bupivacaine for postoperative analgesia in hernia repair.
Material and Methods: After institutional research ethics committee approval, the M.G.M Medical College and M.Y Hospital Anesthesiology Department will conduct this prospective randomised controlled study. Convenient sampling was used90 to randomly assign 30 patients from the American Society of Anesthesiologists physical status grade I–II, age 20–40, to three groups:
Group B (n=30) received TAP blocks on both sides with 18 ml 0.25% bupivacaine and 2 ml normal saline.
Group BM (n=30) patients received TAP blocks on both sides with 18 ml 0.25% bupivacaine, 1.5 ml (150 mg) mgso4, and 0.5 ml NS.
Group BD (n=30) patients received TAP blocks on both sides with 18 ml of 0.25% bupivacaine mixed with 2 ml of NS and 0.5 mcg/kg dexmedetomidine.
A 10-point VAS assessed post-operative analgesia. After securing intravenous lines, all patients received 10-5 ml/kg Inj. Ringer Lactate preloading injections. Premedication consisted of 0.2 mg glycopyrrolate intravenously and 4 mg ondansetron intravenously 30 minutes before surgery.
Results: Combination of 0.25% bupivacaine and 150mg magnesium sulfate and combination of 0.25% bupivacaine and 0.5mcg/kg dexmedetomidine provides longer duration of analgesia compared to 0.25% bupivacaine alone.
Conclusion: When utilized in patients undergoing inguinal hernioplasty, TAP Block with 0.25% bupivacaine offered powerful and longer duration of analgesia, with little any need for diclofenac. There were no side effects linked to TAP Block or the medications being tested.

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