Category Archives: PSR Press

Abstract:Background: Laparoscopic cholecystectomy (LC) is considerably gold standard for symptomatic cholelithiasis. Preoperative prediction of difficult LC and operative grading system may not only improve patient safety but also be beneficial in lessening the overall cost of therapy.
Aim: The present study aimed to predict and analyze risk factors using a scoring system deemed responsible for surgical difficulties in patients undergoing laparoscopic cholecystectomy (LC) for symptomatic cholelithiasis.
Material & Methods: This hospital based prospective study was conducted at Department of Surgery, A tertiary care teaching Hospital, central India. Various factors considered preoperatively were gender, age, previous history of hospitalization, impacted stone, obesity; gall bladder wall thickness, pericholecystic collection; previous abdominal scar and palpable gall bladder were evaluated.
Results: Out of 150 patients, majority of the (34.2%) was 41-50 years age group, predominantly female (62.7%).The scoring system predicted easy LC for 106(70.7%), and difficult for 44(29.3%). No significant association of difficult LC with age group, gender, BMI, h/o hospitalization with acute cholecystitis, abdominal scar, leucocytes count and Hepatic echotexture (P>0.05), whereas palpable gall bladder, GB wall thickness, Distended gallbladder, impacted stone and pericholecystic collection were significantly associated with difficult LC.
Conclusion: Preoperative prediction of the factors leading to difficulty or conversion in cholecystectomy could help plan the surgical strategies and possible outcomes beforehand which can reduce the overall mortality and morbidity.

Abstract:Background: Postoperative pain is a major problem associated with any surgery. Thoracic surgeries result in excessive breakthrough pain which should be countered appropriately to decrease postoperative poor ventilation. Extrapleural paravertebral catheter is one such modality effective for postoperative pain caused by thoracic surgeries, comparable to thoracic epidural. Adjuvants like fentanyl or dexmedetomidine not only reduce the total local anesthetic dose but also provide superior and profound analgesia.
Aims and Objectives: To compare the effect of bupivacaine with fentanyl or with dexmedetomidine via extrapleural paravertebral catheter for continuous postoperative analgesia.
Materials and Methods: Our study was a prospective, randomized, and comparative study conducted in the Department of Anesthesiology, M.Y. Hospital and M.G.M. Medical College, Indore. A total of 40 patients (taking the COVID era into consideration) aged between 18 to 65 years with ASA Grade I, II \& III undergoing thoracic surgeries were included. Patients were divided into two groups of 20 each: Group (B+F) who received 0.125\& Bupivacaine along with Fentanyl 2 mcg/ml @ 0.15ml/kg/hr and Group (B+D) who received 0.125\& Bupivacaine with Dexmedetomidine 0.2 mcg/kg/hr @ 0.1ml/kg/hr via extrapleural paravertebral catheter.
Results: The mean PEFR was comparable between the two groups at 12 hours (P=0.198), 24 hours (P=0.058), 48 hours (P=0.15), and 72 hours (P=0.10). Improvement in PEFR was observed in both groups from 12 hours to 72 hours, with group 1 (B+F) showing 348.00 \(\pm\) 18.317 L/min at 12 hours and 521.50 \(\pm\) 24.468 L/min at 72 hours, while group 2 (B+D) showed 355.50 \(\pm\) 15.39 L/min at 12 hours and 535.00 \(\pm\) 28.562 L/min at 72 hours, indicating improvement in lung function. The mean time taken for the request to first analgesia in Group 1 (B+F) was 259.15 \(\pm\) 11.536 minutes and in Group 2 (B+D) was 360.2 $\pm$ 13.671 minutes, and this mean time was found to be statistically significant between the two groups (P=0.000*).
Conclusion: The mean VAS score (visual analog scale) noted at 72 hours with coughing was better with dexmedetomidine than with fentanyl. The mean time taken for the request to first rescue analgesia in group B+F was 259.15 \(\pm\) 11.536 minutes, and in group B+D, it was 360.20 $\pm$ 13.671 minutes, which was significantly higher in the dexmedetomidine-containing group. A more stable hemodynamic profile was observed in the B+D group.

Abstract:This prospective cross-sectional study aimed to identify clinical patterns of patients admitted with hypoglycemia to the Department of General Medicine at Dhanalakshmi Srinivasan Medical College Hospital in Perambalur between January 2021 and December 2021. The inclusion criteria were patients admitted to the medical ward with documented hypoglycemia (i.e., blood glucose levels < 70 mg/dL) and aged = 18 years. Pregnant women, patients < 18 years, and those unwilling to participate were excluded. Out of 119 patients, the maximum number of patients (54.6%) belonged to the 41-60 age group, while the >60 age group accounted for 34.5%. However, this age group constituted 61.5% of the total deaths, indicating that hypoglycemia in the elderly is a significant predictor of mortality. Dysregulation of glucose metabolism in the body and the failure of endogenous defense mechanisms to combat low blood sugar levels revealed hypoglycemia. Therefore, hypoglycemia should be taken seriously and investigated appropriately. Elderly people are more prone to low blood sugar levels, and in them, diabetes treatment should be moderate. Tight glycemic control in the elderly can lead to fatal episodes of hypoglycemia.

Abstract:Diabetes mellitus affects approximately 13 million people and is associated with various vascular complications. Microvascular and macrovascular problems are common in diabetes, with the latter being similar in both diabetic and non-diabetic patients. The study aimed to estimate the incidence of diabetic foot in patients with diabetes and vascular complications. The study included 330 patients (M:F 170:160) who underwent tests for retinopathy, nephropathy, neuropathy, peripheral vascular disease (PVD), and cardiovascular disease. The results showed that nephropathy was present in 9% of patients, CHD in 12.5%, PVD (diabetic foot) in 12.4%, and neuropathy in 12.5%. Diabetes duration was significantly correlated with neuropathy, nephropathy, and PVD, while higher HbA1C levels were associated with an increased risk of nephropathy and neuropathy. The study highlights the high incidence of diabetic foot in patients with vascular complications.

Abstract:This paper highlights the significance of cadaver dissection as an essential part of medical education and emphasizes the shortage of cadavers in medical colleges. The study aimed to evaluate the knowledge and attitude of medical students towards body donation. The results indicate that a majority of students are willing to donate organs but not their whole body due to concerns about disrespectful behavior in the dissection hall. Moreover, some students were not aware of the legal procedures involved in body donation. The study found no significant difference in opinion based on gender or religion. The findings of this study may be useful in promoting body donation and addressing the shortage of cadavers in medical colleges.

Abstract:Introduction: Fine Needle Aspiration Cytology (FNAC) is a quick, simple, efficient, and inexpensive way to sample superficial masses in the head and neck due to the wide range of primary as well as metastatic neoplasms and the close proximity of several types of tissues. Due to its minimally invasive nature and easy access to target sites, FNAC has gained popularity and acceptance. Although FNAC cannot provide the same level of morphological detail as histology, it can reveal cells from the whole lesion since aspirating allows for many passes through the lesion. In addition to confirming the existence of metastatic disease, FNAC also offers information on the type and origin of the primary tumor. It provides the added advantage of being an outpatient procedure and lowers the frequency of exploratory procedures. The present study was carried out to study the lesions of the anterior triangle of the neck in correlation with histopathology and determine the diagnostic accuracy of FNAC.
Materials and Methods: This prospective observational study was carried out in the Department of Pathology, MGM Medical College and MYH Hospital, Indore, over a period of 2 years (2013-2015), among 1110 patients of both sexes and all age groups with palpable anterior triangle neck swellings reporting in the Department of Surgery, ENT, Pediatrics, TB, and Cancer hospital, who were referred to Pathology. A detailed clinical history was recorded, and a complete physical examination was carried out. FNAC was performed under all aseptic precautions. Cytological findings from the smears were recorded, and a diagnosis was made. Excisional biopsy specimens received were processed and mounted by DPX. Cytohistopathological correlation was done. Data were collected, compiled, and analyzed using SPSS 22.0 (trial version).
Results: Most participants belonged to the age group of 21-30 years. The male to female ratio was reported to be 1:1.35. A large proportion of lesions (71.08%) were found in lymph nodes, while 22.25% were in the thyroid, and the rest (6.67%) were distributed in various other regions. The majority of the lesions (77.12%) in the anterior triangle of the neck were non-neoplastic (inflammatory) lesions. Among the neoplastic lesions located in the thyroid gland, 13.76% were benign and 1.62% malignant. No benign neoplastic lesions were noted in the lymph node. Rather, 14.57% were malignant. Most lesions (38.66%) in the lymph nodes were classified as tuberculous lymphadenitis, followed by reactive hyperplasia of lymph nodes (15.59%). Thyroiditis was most common (84.62%) among the lesions found in the thyroid gland, followed by colloid goiter (8.10%). The sensitivity and specificity were calculated as 85.50% and 99.23%, respectively.
Conclusion: In addition to being safe and comparatively free of complications, FNAC offers a quick, efficient, and accurate approach to diagnosing lesions, especially of the neck. Consistent results were found between cytological and histological examinations, and hence it works as a useful adjunct to histopathology. It can help to significantly reduce morbidity and mortality by early as well as accurate diagnosis of benign and malignant lesions.

Abstract:Background: Conversion disorder is a prevalent psychiatric illness characterized by various clinical patterns, including visual paralysis, dystonia, psychogenic non-epileptic seizures, anesthesia-like symptoms, swallowing problems, motor tics, and difficulty walking. These symptoms vary greatly from case to case and can vary in the same patient during successive episodes. Most symptoms are related to life stressors.
Study design: A cross-sectional study was conducted to estimate the sociodemographic profile, types of stressors, and variety of clinical symptoms presented in patients with conversion disorder in a tertiary care center in the North-East region of India. A total of 74 patients diagnosed according to Diagnostic and Statistical Manual of Mental Disorders Fifth Edition criteria were included. Patients underwent assessments of comorbidity using the Hamilton Depression Rating Scale, Hamilton Anxiety Scale, and assessments of stressful life events using the Presumptive Stressful Life Event Scale.
Result: The most common lifetime stressor was excessive alcohol use by family members with financial loss or problems (43.7%). Immediate stressors prior to the onset of illness were broken engagement or love affair (25.7%), family conflict (24.3%), marital conflict (14.9%), examination-related problems (10.8%), and other problems (23%). Motor symptoms were the most common type of clinical presentation (58.4%), with pseudo-seizures being the most common (29.7%). Other motor symptoms included paresis of the lower limb (9%), paresis of the left-side upper and lower limb (2.7%), aphonia/dysphonia (12.2%), limb paralysis (1.4%), dysphasia (2%), and ataxia (1.4%). Conversion disorder with mixed motor and sensory deficit (multiple fainting spells) was found to be the most common symptom (37.8%) in this region.

Abstract:Background: Hypertension is a major cause of death worldwide. The increasing prevalence of hypertension in young individuals is a warning sign of the impending cardiovascular, cerebrovascular, and renal diseases in the future. Hypertension affects 1 in 8 adults between the ages of 20 and 40 years and this number is likely to increase with unhealthy lifestyle behaviors and the lowering of hypertension diagnostic thresholds. Although the mechanisms are unclear, early-life factors have been found to influence blood pressure (BP), and BP tracks strongly within individuals from adolescence through to later life. Higher BP at a young age is associated with abnormalities on heart and brain imaging and increases the likelihood of cardiovascular events by middle age. However, young patients often have lower diagnosis rates, and their treatment is often delayed.
Methods: This prospective observational study was conducted from January 2021 to March 2021 in a tertiary care hospital. A total of 50 cases, male and female, were studied based on inclusion and exclusion criteria. Routine investigations were done on all patients, and uric acid and lipid profiles were sent to evaluate the association. Patients’ height and weight were recorded to calculate BMI. Patients below 12 years, pregnant women, and patients with previous cardiovascular and secondary causes of hypertension were excluded from the study. The study was carried out in all patients who fulfilled the inclusion and exclusion criteria.
Results: During the study period, a total of 50 patients (27 females and 23 males) were included. Our study revealed a female preponderance in the ratio of 1:1.1. More patients were in the age group of 40-45 years. Overweight was significantly noted with BMI >25 in 30 patients and >30 in 10 patients. Uric acid was significantly increased in 27 patients. Lipid abnormalities were noted: LDL increased in 30 patients, TGL increased in 32 patients, HDL increased in 20 patients, Total Cholesterol in 25 patients, and VLDL increased in 25 patients.
Conclusions: Our study showed that BMI was significantly higher in hypertensive patients. Furthermore, lipid abnormalities were present in overweight patients, contributing to hypertension. Although uric acid was elevated in a significant number of patients, it did not emerge as a risk factor in young hypertensives. We recommend a healthy lifestyle and a disciplined diet to avoid the hazards of hypertension.

Abstract:The COVID-19 pandemic has affected both the physical and psychological well-being of those who have been infected or have lost loved ones. Among those most affected are healthcare workers who have been on the frontline throughout the pandemic. This study aims to assess the levels of anxiety and depression among healthcare workers and their association with various demographic parameters. Additionally, we sought to determine the association between the Global Fatigue Index (GFI) and HADS score. Of the participants, 12 (16.22%) had borderline HADS scores (8-10) and 4 (5.41%) had abnormal HADS scores for depression (11-21). Furthermore, 13 (17.57%) had abnormal HADS scores for anxiety. HADS scores for both anxiety and depression were associated with female gender, profession (paramedic staff were more affected than doctors), and income. The GFI was calculated using the Multidimensional Assessment of Fatigue (MAF) score and found to have a positive correlation with various demographic parameters as well as with the HADS score, indicating that psychological stress has an impact on physical well-being and can lead to prolonged fatigue, thereby affecting an individual’s working capacity.

Abstract:Twenty-six patients with massive combat injuries to the lower extremities were treated with Ilizarov bone transport and free flap coverage. In all cases, debridement was performed thoroughly and with caution, followed by free flap coverage and external fixator application. The Ilizarov transport method using ring fixators was applied 4-6 weeks later, with distraction osteogenesis beginning 2-3 days later. The segmental bone defects ranged from 5cm to 16cm in the greatest dimension, and the total disability time from initial injury ranged from 14-26 months. However, two patients experienced partial flap necrosis, which was later treated with local transposition flap cover and split skin graft. Despite the late treatment, successful results were obtained in all 26 patients, with the original length of the tibia maintained and timely definitive treatment provided for the massive injuries of the lower extremities. Thus, the Ilizarov transport method used in combination with free flap coverage provides an effective therapy for repairing massive injuries to the lower extremities.