Acharya Vinoba Bhave Rural Hospital Research Articles

A prospective observational cross-sectional study on the association of non-alcoholic fatty liver disease and insulin resistance in acute ischemic stroke in tertiary care hospital in Central India

Background Non-alcoholic Fatty Liver Disease (NAFLD) and insulin resistance have individually been associated with increased cardiovascular risk, and their potential interplay in the context of Acute Ischemic Stroke remains a subject of investigation. This study aims to elucidate the association between NAFLD, insulin resistance, and Acute Ischemic Stroke, exploring risk factors, etiology, and potential implications for patient management. Methods This prospective observational cross-sectional study will be conducted at Acharya Vinoba Bhave Rural Hospital, enrolling patients aged 40-79 diagnosed with acute ischemic stroke between 2022 and 2025. Diagnostic confirmation will involve brain imaging, and abdominal ultrasonography will assess NAFLD severity. Biochemical parameters will be measured for insulin resistance evaluation, including blood glucose, glycosylated hemoglobin (HbA1c), and fasting insulin levels. The Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) will be calculated. Statistical analyses, including descriptive statistics and bivariate and multivariate analyses, will be applied to explore associations and potential risk factors. Expected Outcome Anticipated findings include insights into the prevalence and severity of NAFLD in Acute Ischemic Stroke patients, the association between insulin resistance and stroke incidence, and potential risk factors contributing to this association. The study provides a foundation for understanding the complex relationship between NAFLD, insulin resistance, and Acute Ischemic Stroke, offering valuable implications for risk stratification and patient management in clinical practice. Identifying modifiable risk factors may guide targeted interventions, contributing to improved outcomes in this patient population.

Accuracy of chronic liver failure consortium (CLIF-C) ACLF score compared with meld, MELD-NA and CTP as a mortality predictor in acute on chronic liver failure patients admitted to tertiary rural care hospital

Background Chronic Liver Failure Consortium (CLIF-C) ACLF score, Model for End-Stage Liver Disease (MELD), MELD-Na, and Child-Pugh (CTP) are established scoring systems for predicting mortality in Acute on Chronic Liver Failure (ACLF) patients. However, their comparative accuracy, especially in rural care settings, still needs to be explored. This study aims to assess and compare the predictive performance of these scoring systems, providing a nuanced understanding of their applicability in a tertiary rural care hospital. Method This prospective observational cohort study will be conducted at Acharya Vinoba Bhave Rural Hospital, following approval from the institutional ethical committee. ACLF patients aged 18 and above, presenting within one week of onset, will be included. Data collection will involve comprehensive assessments, including scoring system calculations, clinical examinations, and relevant investigations. Statistical analyses, encompassing descriptive statistics, comparative analyses, survival analyses, and multivariate models, will elucidate the accuracy and independent predictors of 28-day mortality. Expected Outcome Anticipated outcomes include a comprehensive understanding of the strengths and limitations of the CLIF-C ACLF score, MELD, MELD-Na, and CTP in predicting mortality among ACLF patients in a rural care context. The study aims to identify potential correlations and independent predictors, offering valuable insights for risk stratification. These findings are expected to guide clinicians in optimising prognostic assessments and decision-making, thereby improving the care and outcomes of ACLF patients in rural healthcare settings.

MRI based evaluation of carcinoma gallbladder using apparent diffusion coefficient (ADC) and diffusion weighted imaging (DWI)

Background Carcinoma of the gallbladder is a malignant neoplasm, which is associated with a poor prognosis due to its often-asymptomatic nature and late-stage diagnosis. Non-invasive imaging techniques play a key role in the early detection and characterization of gallbladder carcinoma. This thesis presents a comprehensive analysis of the utility of Diffusion-Weighted Imaging (DWI) and Apparent Diffusion Coefficient (ADC) mapping in the magnetic resonance imaging (MRI) evaluation of carcinoma of the gallbladder. The primary objective of this research was to investigate the exact diagnostic accuracy and potential clinical applications of DWI and ADC in assessing carcinoma of the gallbladder and related tumour aggressiveness. A systematic review of existing literature was conducted to establish a foundation for this study with efforts to acquire relevant imaging data. The results of this study demonstrate the efficacy of DWI and ADC in the detection of carcinoma of the gallbladder when compared to conventional MRI sequences. These advanced imaging techniques hold promise in increasing the accuracy of diagnosis, ultimately leading to improved patient outcomes and more informed clinical decision making. The potential of Diffusion-Weighted Imaging (DWI) and Apparent Diffusion Coefficient (ADC) mapping in the evaluation of gallbladder cancer using magnetic resonance imaging (MRI) is thoroughly analysed in this thesis. Methods A descriptive prospective study will be done at Acharya Vinoba Bhave Rural Hospital, Sawangi, involving 20 patients with clinically suspected carcinoma gallbladder, who are referred to the department of Radiodiagnosis. These patients will be subjected to study-purposive sampling. Conclusion After an appropriate statistical analysis, we expect to assess the role of Diffusion-Weighted Imaging (DWI) and Apparent Diffusion Coefficient (ADC) mapping in the magnetic resonance imaging (MRI) evaluation of carcinoma of the gallbladder. CTRI registration This trial has been submitted to Clinical Trials Registry-India (CTRI) for Review. Registration Number: REF/2023/09/072780 Registration date:01/05/2023 URL of trial: https://www.ctri.nic.in/

Randomised control trial on management of early avascular necrosis of femoral head by core decompression with bisphosphonate therapy versus core decompression in tertiary care hospital in central India

Background This study outlines a randomised control trial to assess the efficacy of Core Decompression with and without Bisphosphonate Therapy in managing early Avascular Necrosis of the femoral head. Avascular Necrosis, a debilitating condition, necessitates exploration of interventions to mitigate progression. The trial is conducted at Jawaharlal Nehru Medical College and Acharya Vinoba Bhave Rural Hospital, Sawangi, Wardha, focusing on clinical, radiographic, and patient-reported outcomes. Methods Skeletally mature participants diagnosed with stage 1 or 2 Avascular Necrosis of the femoral head will be randomly assigned to either Core Decompression with Bisphosphonate Therapy or Core Decompression Alone. Data collection from July 2022 to September 2024 will involve preoperative assessments, intraoperative details, postoperative care records, and followup evaluations at six weeks, three months, six months, and nine months. Statistical analyses will encompass primary outcomes assessed by Harris Hip Score, secondary outcomes including pain reduction and radiographic changes, and subgroup analyses. Expected Outcome Anticipated outcomes involve insights into the comparative effectiveness of the two interventions. Primary analyses will reveal variations in Harris Hip Score changes over time, while secondary analyses will shed light on pain reduction, radiographic changes, and potential complications. Subgroup analyses may discern nuances based on etiological factors. The results aim to inform clinical practice, guiding the optimal management of early Avascular Necrosis of the femoral head.

A Comparative Study between Intermittent Smead Jones Rectus Closure and Continuous Rectus Closure in Midline Laparotomy Wound

This comparative study delves into the efficacy and impact of two primary closure techniques, intermittent Smead Jones rectus closure, and continuous rectus closure, on midline laparotomy wound management. Aimed at offering evidence-based guidance to surgeons, this investigation encompasses a prospective observational study involving 98 patients aged ≥18 undergoing midline exploratory laparotomy at Acharya Vinoba Bhave Rural Hospital Sawangi. Divided into two groups—intermittent S-J closure and continuous closure—the study will meticulously assess wound parameters and complications, notably focusing on wound dehiscence, burst abdomen, and incisional hernia repair rates. Spanning from February 2023 to May 2025, the research aims to scrutinize statistical outcomes using SPSS and MS Excel, seeking to provide critical insights into these closure techniques’ comparative effectiveness. Despite its limitations, including a relatively small sample size and an observational nature without interventions, this study aspires to contribute valuable data that can aid surgeons in optimizing closure methods for midline laparotomy wounds, thereby enhancing postoperative outcomes and patient care.

Comparative study between efficacy of topical tofacitinib 2% ointment versus topical clobetasol propionate 0.05% ointment in hand eczema at a tertiary hospital in central India

Background Hand eczema is a prevalent dermatological condition that significantly impacts the quality of life of affected individuals. Topical corticosteroids, such as Clobetasol Propionate, are commonly employed for management, but concerns regarding long-term use and potential side effects necessitate exploration of alternative treatments. This study protocol outlines a randomized controlled trial comparing the efficacy of topical Tofacitinib 2% ointment with Clobetasol Propionate 0.05% ointment in managing hand eczema. Methods The study will be a single-blinded, parallel-group, randomized controlled trial conducted at the Dermatology outpatient department of Acharya Vinoba Bhave Rural Hospital Sawangi Meghe, Wardha, from March 2023 to September 2025. Eligible participants diagnosed with hand eczema will be randomized into two groups: Group 1 will receive Clobetasol Propionate 0.05% ointment, and Group 2 will receive Tofacitinib 2% ointment. The primary outcome measure is the change from baseline in the Hand Eczema Severity Index (HECSI) score, assessed at two weeks and four weeks. Statistical analysis will utilize appropriate parametric and non-parametric tests, with a p-value <0.05 considered significant. Expected Outcome The study is anticipated to provide insights into the comparative efficacy and safety of Tofacitinib and Clobetasol Propionate in managing hand eczema. A favorable outcome for Tofacitinib could suggest its potential as an alternative or adjunctive therapy, offering a more targeted approach with fewer side effects. The findings may contribute to optimized treatment strategies for hand eczema, improving patient outcomes and guiding future research in dermatological therapeutics.

Hospital based interventional study implementation of supervised quality improvement protocol in reducing surgical site infections in obstetrics and gynaecological major surgeries: A study protocol

Background Surgical site infections (SSIs) pose a significant challenge in obstetric and gynaecological surgeries, with incidence rates ranging from 0.5% to 15%. These infections not only impact patient outcomes but also contribute to extended hospital stays and increased healthcare costs. To address this issue, a hospital-based interventional study is proposed, focusing on the implementation of a comprehensive quality improvement protocol within the Department of Obstetrics and Gynecology at Acharya Vinoba Bhave Rural Hospital (AVBRH), Wardha. Methods The study will include approximately 800 obstetric and gynaecological surgeries per year. Ethical approval has been obtained and written informed consent will be obtained from all enrolled women. The intervention involves the implementation of a surgical site infection prevention quality improvement protocol, encompassing elements such as standardized pre-operative antiseptic agents, proper cleaning procedures, and the use of injectable cefazolin. A structured proforma will be developed for data collection, covering demographic details, surgical parameters, surgeon characteristics, and post-operative outcomes. Expected outcome This study aims to assess the efficacy of the quality improvement protocol in reducing the incidence of surgical site infections. We anticipate that the implementation of this protocol will lead to a significant reduction in SSIs, improving patient outcomes and safety in obstetric and gynaecological surgeries. The study's findings will not only contribute to the body of knowledge on infection prevention but will also serve as a valuable framework for enhancing surgical safety in similar healthcare settings. Continuous evaluation and refinement of the protocol will be crucial for sustained success in reducing SSIs and improving overall patient care.

A cross-sectional study approach towards management of ovarian tumour by frozen section at laparotomy and assessing its validity by gold standards of histopathology

Background Ovarian tumours represent a complex clinical challenge, requiring accurate diagnosis to guide appropriate surgical management. This study protocol outlines a cross-sectional investigation to evaluate the diagnostic accuracy of frozen section analysis during laparotomy for ovarian tumours, comparing it with the gold standard of histopathology. Methods The study will be conducted over two years (2022-2024) at the Department of Obstetrics and Gynaecology, Acharya Vinoba Bhave Rural Hospital (AVBRH), Wardha, India. Fifty eligible patients with ovarian masses will be included, with data collected through comprehensive demographic and clinical assessments, ultrasonography, and computed tomography scans. Frozen section analysis will be performed during staging laparotomy, and diagnoses will be compared with final paraffin-embedded histopathological results. Statistical analyses will be conducted to assess diagnostic accuracy, including sensitivity, specificity, positive predictive value, and negative predictive value. Expected outcomes The study aims to provide insights into the effectiveness of frozen section analysis as a real-time diagnostic tool for ovarian tumours, with implications for surgical decision-making. The results will be presented in peer-reviewed journals and conferences, enhancing clinical practice in gynecologic oncology.

A prospective randomized comparative study of effectiveness of simulation-based training in improving the performance of non-technical skill among postgraduate students during anaesthesia crisis resource management

Background Non-technical skills are pivotal in ensuring patient safety during anaesthesia crisis resource management. Simulation-based training has emerged as a promising educational approach for enhancing these skills. This study protocol outlines a prospective randomised comparative study aimed at assessing the impact of simulation-based training on the performance of anaesthesia residents during anaesthesia crisis resource management, with a focus on task management, teamwork, situational awareness, and decision-making skills, using the Assessment of Non-Technical Skills (ANTS) scoring system. Methods Anesthesia residents in postgraduate years 1 and 2 from the Department of Anesthesia at Acharya Vinoba Bhave Rural Hospital will be included as study participants. Informed consent will be obtained, and no exclusion criteria will be applied. Participants will undergo an orientation session covering essential crisis management and simulation knowledge. The study will employ advanced simulation equipment, including a Human Patient Simulator (HPS) mannequin, an anaesthesia machine, and a simulated operating room. Faculty members have selected six distinct perioperative emergency scenarios for simulation sessions. Participants will be grouped in pairs and exposed to three scenarios during each session. Debriefing and feedback will follow each scenario, reinforcing non-technical skills. Experienced staff anesthesiologists, trained in the Assessment of Non-Technical Skills (ANTS) scoring system, will serve as assessors to evaluate participant performance. Expected outcomes Data collected will include ANTS scores, debriefing feedback, and post-test results. Statistical analysis will be employed to assess the effectiveness of simulation-based training in enhancing non-technical skills among anaesthesia residents during anaesthesia crisis resource management.

A cross-sectional observational study on quality assurance and radiation safety in interventional radiology

Background Interventional Radiology (IR) is anticipated to play an increasingly pivotal role in modern healthcare, providing vital minimally invasive procedures for diagnosis and treatment. As the frequency and complexity of IR procedures continue to evolve, maintaining impeccable standards in quality assurance (QA) and radiation safety becomes paramount. This study is designed to assess prevailing QA practices comprehensively, gauge adherence to forthcoming radiation safety guidelines, and proactively identify areas primed for advancement within diverse interventional radiology units. Methods Employing a prospective cross-sectional observational design on 48 health professionals, an array of healthcare facilities, each equipped with a state-of-the-art IR unit, will be purposefully selected. The study cohort will encompass diverse participants, including interventional radiologists, radiologic technologists, nurses, and medical physicists. The study will be conducted in the Acharya Vinoba Bhave Rural Hospital’s facilities equipped with interventional radiology units. Analysis will be done by using R studio version 4.3.1 by using t-test and chi-square. Expected results The anticipated quantitative data analysis will undoubtedly yield nuanced insights into the participants’ multifaceted roles, experiences, and prospective perceptions concerning QA and radiation safety practices. In equal measure, the quantitative analysis is poised to uncover recurring thematic strands about the efficacy of current QA frameworks, radiation safety protocols, and the multifarious challenges envisaged in maintaining elevated standards. Study implication As this study unfolds, it will illuminate the evolving landscape of QA and radiation safety intrinsic to interventional radiology. This study is poised to guide future practice improvement, refine training paradigms, and shape forthcoming policies within this dynamic field by casting a discerning eye on potential gaps and imminent challenges. The conclusive insights are anticipated to underscore the enduring commitment required to ensure the safety of patients and healthcare professionals, concurrently fostering the pioneering trajectory of interventional radiology procedures.

Central Corneal Thickness and Endothelial Cell Changes in Diabetics and Age-Matched Non-diabetics in a Tertiary Care Hospital in Central India.

Background Diabetes has become an epidemic, significantly impacting ocular health as one of its end-organ responses. Among the various ocular complications, alterations in corneal morphology stand out. Central corneal thickness (CCT) and endothelial cell function are vital parameters in assessing intraocular pressure, conducting pre-refractive surgery evaluations, and maintaining corneal transparency. Understanding these changes in diabetic individuals compared to non-diabetics is crucial for managing ocular health in this population. Aim and objective This study evaluates and compares CCT and endothelial cell changes between diabetic individuals and age-matched non-diabetics. By analyzing these parameters, the study seeks to provide insights into the impact of diabetes on corneal morphology and its implications for ocular health. Methods The study recruited 124 patients from the Ophthalmology Outpatient Department (OPD) at Acharya Vinoba Bhave Rural Hospital (AVBRH), Sawangi. A cross-sectional research design was employed to collect data over six months. Patients were carefully selected, and informed consent was obtained from all participants. CCT and endothelial cell parameters were assessed using specular microscopy, a non-invasive imaging technique. Statistical analysis was done using the software Statistical Package for the Social Sciences (SPSS) for inferential statistics, such as t-tests and ANOVA, and comparing parameters between diabetic and non-diabetic groups.Findings were interpreted based on both statistical significance and clinical relevance. Results In diabetic patients, the mean CCT was 547.91 µm, while it was 523.62 µm in non-diabetic individuals.The T statistic for this variable was 5.14, indicating a17 significant differencebetween the two groups. Similarly, significant differences were found between diabetics and non-diabetics for endothelial cell density, coefficient of variation, and hexagonality, as evidenced by their respective T statistics of 7.46, 5.17, and 4.91. Endothelial cell density averaged 2375 cells/mm2 in diabetics and 2666.95 cells/mm2 in non-diabetics. Additionally, the coefficient of variation was higher among people with diabetes (40.87%) compared to non-diabetics (35.09%). Hexagonality, a measure of endothelial cell shape, was lower in diabetic corneas (40.48%) than in non-diabetic corneas (46.46%). Conclusion The study observed significant differences in corneal morphology, including central thickness and endothelial cell changes, between diabetic and non-diabetic individuals. These findings underscore the impact of diabetes on ocular health and emphasize the importance of monitoring corneal parameters in diabetic patients. Understanding these changes can aid in better management and treatment strategies for ocular complications associated with diabetes.

Assessing the Prevalence Rate of Gangrene Among Patients With Peripheral Vascular Disease in a Tertiary Care Hospital in Central India.

Background Peripheral vascular disease (PVD) includes peripheral arterial disease (PAD) and venous disease. PAD is a chronic progressive atherosclerotic disease leading to partial or total peripheral vascular occlusion. PAD typically affects the abdominal aorta, iliac arteries, lower limbs,andoccasionally theupper extremities. Assessing the prevalence of gangrene among PVD patients is crucial for understanding the burden of this condition and informing clinical management strategies. This study aimed to estimate the prevalence rate of gangrene among patients diagnosed with peripheral vascular disease. Methods This case-control study was conducted at the General Surgery department of Jawaharlal Nehru Medical College and Acharya Vinoba Bhave Rural Hospital, Wardha, India. Patients diagnosed with PVD who presented with gangrene of the lower limb were included. Detailed demographic data were collected, and clinical examinationsand diagnostic tests were performed to assess the severity and extent of gangrene. Statistical analysis was conducted to estimate the prevalence of gangrene among PVD patients. Results Among the 100 participants, the age distribution ranged from 21 to over 70 years, with a mean age of 52.89. Gender distribution showed that 30% of the participants were female and 70% were male. The prevalence of gangrene among PVD patients was found to be 35%, with 65% patients not presenting with gangrene. Conclusion The findings of this study highlight the significant prevalence of gangrene among patients diagnosed with peripheral vascular disease. The implications of these findings for clinical practice and management strategies are discussed further, along with potential avenues for further research. The study provides valuable insights into the burden of gangrene among PVD patients. Early detection and appropriate management of PVD are crucial for preventing the development of gangrene and improving patient outcomes.

Correlation Between Hypothyroidism and Gallstone Disease in Central India.

Introduction The decreased thyroid-stimulating hormone (TSH) levels affect almost every nucleated cell in our body, which directly affects the basal metabolic rate (BMR). It tends to affect multiple organ systems in the human body. In recent times, there have been changes inlifestyle and the consumption ofprocessed foods has increased. Thus, cholelithiasis and hypothyroidism are being encountered frequently, even in rural populations. In recent times, the overt clinical presentation of hypothyroidism is rare due to early diagnosis and treatment of the subclinical hypothyroidism state itself. Aim The aim is to determine the correlation betweencholelithiasis and hypothyroidism. Methods This was a cross-sectional study done on the patients presenting to the surgical department at Acharya Vinoba Bhave Rural Hospital affiliated to Jawaharlal Nehru Medical College, Sawangi (Meghe), Wardha, Maharashtra, India between the duration from December 2020 to December 2022, having gallstone disease or with symptoms suggestive of gall bladder stones. The admitted patients were then evaluated for hypothyroidism by thyroid profile tests, and the results were documented. Using the collected data, factors such as clinical spectrum, correlation between cholelithiasis and hypothyroidism, relation with the demographic data, and body mass index (BMI) were studied. Results A total of 52 gallstone patients were included in the study. A greater number of patients were found to be above the age of 40 years (82.7%), with female preponderance (61.5%).More patientswith cholelithiasis were from the group with having BMImore than normal (57.6%).More patients having both cholelithiasis and hypothyroidism were also from the group with having BMI more than normal. Mostsymptomatic patients complained ofpain in the right hypochondriac region (88.5%). Of these 52 patients, nine (17.3%) were found to have hypothyroidism (seven were subclinical, two patients had overt clinical symptomsand signs)and theremaining 43 patients were euthyroid. Conclusions Our study supports that there is a correlation between cholelithiasis and hypothyroidism. Out of all the 52 patients, nine had hypothyroidism, seven were subclinical, and two had overt symptoms. Thus, we conclude that there is a correlation between cholelithiasis and hypothyroidism.

A cross-sectional study on serum uric acid as an early marker in predicting the mortality and morbidity in patients with sepsis

Introduction Sepsis is a critical medical condition characterized by a dysregulated host response to infection, often resulting in acute organ dysfunction. Early diagnosis and timely intervention are essential for improving outcomes in sepsis patients. This study protocol outlines a cross-sectional investigation into the potential prognostic value of serum uric acid levels in sepsis cases, aiming to contribute to the early identification and management of this life-threatening condition. Methods The study will be conducted at the Acharya Vinoba Bhave Rural Hospital, a tertiary care teaching hospital in Wardha District. Patients aged 18 years and above, diagnosed with sepsis or septic shock according to the Third International Consensus definition, will be included. Detailed clinical data will be collected, including comorbidities, vital signs, and organ dysfunction scores. Serum uric acid levels will be measured upon admission and at recovery from sepsis or seven days of non-recovery. Expected outcomes The primary outcome is assessing whether serum uric acid levels can be an early marker for sepsis diagnosis and prognosis. Secondary outcomes include evaluating the correlation between uric acid levels and mortality rates, organ dysfunction severity, inflammatory response, treatment response, and hospital length of stay. Additionally, serum uric acid’s prognostic value will be compared with established biomarkers for sepsis.

Protocol for a prospective comparative randomized clinical study for the comparison of two different doses of dexmedetomidine with bupivacaine in pediatric caudal anesthesia for infraumbilical surgeries in a tertiary hospital in central India

Background Pediatric caudal anesthesia is a well-established technique for providing intraoperative and postoperative pain relief in children undergoing infraumbilical surgeries. Dexmedetomidine, an α2-adrenergic agonist, has shown promise as an adjuvant to local anesthetics in caudal blocks, potentially improving the quality and duration of pain relief. This study aims to compare two doses of dexmedetomidine with bupivacaine to assess their efficacy in pediatric caudal anesthesia. Methods A prospective comparative randomized clinical study will be conducted over two years in the Department of Anaesthesiology at Jawaharlal Nehru Medical College (JNMC) and Acharya Vinoba Bhave Rural Hospital (AVBRH) in Central India. Patients aged six months to six years, with American Society of Anesthesiologists (ASA) Class 1 or 2, scheduled for infraumbilical surgeries, will be included. They will be randomly allocated to receive either Group A (1 ml/kg of 0.25% bupivacaine with 1 μ/kg dexmedetomidine) or Group B (1 ml/kg of 0.25% bupivacaine with 0.5 μ/kg dexmedetomidine) in a double-masked fashion. The primary outcome is the duration of postoperative pain relief. Secondary outcomes include intraoperative hemodynamic stability, time first to rescue analgesia, incidence of adverse effects, and patient and parent satisfaction. A cost-effectiveness analysis will also be conducted. Conclusions The study will provide insights into the efficacy and safety of different doses of dexmedetomidine in pediatric caudal anesthesia for infraumbilical surgeries. The results will guide clinical practice and inform anesthesia protocols for pediatric patients in the study setting. Registration CTRI (CTRI/2023/05/057050; 29 August 2023).

Surgical Outcomes of Tympanoplasty with Various Graft Materials in Chronic Otitis Media: A Retrospective Cohort Study

Introduction: Chronic Otitis Media (COM) is a common ear disorder that predominantly affects underdeveloped countries. It is characterised by persistent middle ear discharge and a perforated Tympanic Membrane (TM). Management typically involves antibiotics and surgical techniques like tympanoplasty to eradicate infections and improve the auditory conduction system. Various graft materials are used, with temporalis fascia being preferred due to its proximity and ease of harvesting. Aim: To evaluate the surgical outcomes of tympanoplasty procedures utilising different graft materials in patients diagnosed with inactive mucosal COM. Materials and Methods: This retrospective cohort study was conducted in the Department of Otorhinolaryngology at Acharya Vinoba Bhave Rural Hospital (AVBRH), Wardha, Maharashtra, India, between June 1, 2013, and May 31, 2023. A total of 165 participants with inactive mucosal COM, who had small to subtotal central perforations of the TM, were included. Tympanoplasty, performed by the same surgeon using the Zeiss surgical microscope model OPMI under general anaesthesia, was the chosen surgical procedure. All cases were executed using the postauricular approach with the underlay technique. A successful anatomical outcome was defined as an intact neoTM without residual perforation at the end of a three-month follow-up. Results: The age of participants ranged from 10 to 75 years, with a mean age of 32.45±14.06 years. The age group most frequently affected by mucosal COM was between 31-40 years, comprising 41 (24.85%) cases. Large perforations were observed in 79 (47.88%) patients, followed by moderate perforations in 65 (39.39%) patients. Normal ossicular chains were found in 163 (98.78%) patients, while ossicular erosion was noted in 2 (1.22%) patients during surgery. A total of 118 (100%) patients who came for follow-up, 84 (71.19%) who underwent temporalis fascia graft reconstruction showed successful graft uptake. Conclusion: This study found that both fascia and cartilage tympanoplasty are suitable for TM repair due to their availability.

Study of Methicillin-resistant Staphylococcus aureus Isolated from Various Clinical Specimens from Tertiary Care Hospital

ABSTRACT Introduction: Staphylococci are Gram-positive bacteria, with a diameter of 0.5–1.5 μm and individual cocci, which are divided in more than one plane from the grape-like cluster. In the genus staphylococci, 32 species and 8 subspecies are present in many of which are present as a commensal in the human body. Staphylococci are frequently found as a normal flora of skin mucosal, surface of respiratory, upper elementary, and urogenital tract of the human body. In immunocompromised condition, the infection can be spread by skin-to-skin contact and also by excretion such as saliva aerosol releasing during sneezing and coughing. Infection of staphylococci may also spread from the animal product such as nonpasteurized milk and milk products. Over the last few decades, Staphylococcus aureus has emerge as the most dangerous organism, which is known as methicillin-resistant S. aureus (MRSA). Some strains show vancomycin resistance by S. aureus in hospitalized patients. The present study was conducted to study the prevalence and antibiogram of MRSA isolates in a clinical sample from Acharya Vinoba Bhave Rural Hospital. Materials and Methods: This study was conducted in the Department of Microbiology at Jawaharlal Nehru Medical College (Datta Meghe Institute of Higher Education and Research), Wardha, from August 2020 to December 2021. The samples received in the microbiology laboratory were inoculated on blood agar and MacConkey’s agar, and incubated for 24 h at 37°C for staphylococcal isolation. A total of 145 Staphylococcal aureus were isolated and confirmed by Gram stain and various biochemical tests such as catalase test, oxidase test, coagulase test, and mannitol salt agar. Antibiotic susceptibility test was examined on the Mueller–Hinton agar plate using the modified Kirby–Bauer disc diffusion method. Screening of methicillin resistant was performed by cefoxitin (30 μg) disc diffusion method and interpreted according to CLSI guideline. Results: The prevalence of MRSA was 76 (52.41%) to methicillin-susceptible S. aureus. The highest MRSA was found in the age group >50 years (26.31%). Out of 76 MRSA isolates from different departments, the medicine and orthopedic departments show maximum MRSA as 19.74% each followed by pediatrics (17.11%) and surgery (13.16). Out of 76 MRSA isolates, vancomycin showed 93.42% sensitivity followed by linezolid (85.52%), Gentamicin (71.05%), tetracycline (56.57%), clindamycin (46.05%), and erythromycin (31.57%). Conclusion: With the advancement of new therapeutic agent, MRSA is also being easily resistant. Due to increasing cases of MRSA, there is an increase in the rate of morbidity and mortality. Moreover, except vancomycin, other drugs are resistant, as their MIC is not in the susceptible range. Thus, the results of this study indicate that vancomycin is a suitable medication to take when MRSA cases rise. In such cases, MRSA can be controlled by regular monitoring and checking the irrational use of antibiotics.

Comparing the Combination of Banana Consumption and Deep Breathing Exercises with Banana Consumption Alone and Deep Breathing Exercises Alone for Anxiety, and Depression among Postmenopausal Women: A Research Protocol

Introduction: Sleep disturbances are associated with increased healthcare costs and negative health outcomes. Oestrogen levels decrease after menopause, which may also be accompanied by deterioration in cognitive function along with the symptoms of depression and depressive disorders. Need for the study: The need of the study is evident in postmenopausal women, where physiological changes lead to a decline in vital hormones such as oestrogen and melatonin, contributing to anxiety, depression, and obstructive sleep apnoea. Consuming fruits rich in tryptophan which is a precursor of melatonin and serotonin can reduce sleep disorders and enhance sleep quality. Fruits containing tryptophan and melatonin can improve the sleep quality of healthy adults when consumed for seven days. Bananas are the prime example of nutritious food which enhances the mood-boosting benefits of serotonin. Deep breathing exercises are effective in reducing menopausal symptoms and help to manage stress related to life and menopause. Aim: To evaluate and compare the efficacy of a combination of banana consumption and deep breathing exercises with banana consumption alone and deep breathing exercises alone for managing sleep deprivation, anxiety, and depression among post-menopausal women. Materials and Methods: A random 3-arm parallel intervention study will be carried out at Acharya Vinoba Bhave Rural Hospital, Sawangi Meghe Wardha, and Near Mai Hospital, Gandhi Nagar Arvi Naka Wardha, Maharashtra, India. The study will be conducted from May 2023 to May 2026. A random sampling technique will be used to select the sample. A total of 135 post-menopausal women, meeting the inclusion criteria will be chosen for the study. The Pittsburgh Sleep Quality Index (PSQI) will be used to evaluate sleep deprivation, the self-rating anxiety and depression scale will be used to assess depression and anxiety, and serum magnesium tests along with demographic variables will be recorded. Statistical analysis will be performed using Analysis of Variance (ANOVA), among the outcome variables between the three groups. A p-value less than 0.05 will be considered as statistically significant.

A rare presentation of Rubinstein-Taybi syndrome

Objective. Taybi syndrome is a rare genetical disorder with the symptoms of small stature, broad thumbs and first toes, a moderate to severe intellectual handicap, and unique facial traits. The present case study aimed with diagnose and therapeutic management of pediatric patients having Rubinstein-Taybi syndrome. Study area. The case study was carried out in Jawaharlal Nehru Medical College, Acharya Vinoba Bhave Rural Hospital, Sawangi Meghe, Wardha, Maharashtra, in department of Pediatrics. The present study follows case of male child, diagnosed with different degrees of compliance, in which the therapeutic approach was determined by the severity of the patient’s conditions. Outcomes. Case study on 3 years old male child was carried out and observed with some behavioural changes like unstable mood, distractibility and impulsivity along with attention problem, aggressive nature and self-injurious behavior etc. As the syndrome does not have a particular treatment but some therapies are applied to address issues that are frequently connected to the illness. The thumbs or toes surgically repaired might enhance grip or ease pain. The study was performed as per the scientific way, based on research literatures study.

Umbilical Artery Doppler Indices in Hypertensive Disorders of Pregnancy: Impact on Fetal Outcomes.

Background Hypertensive disorders of pregnancy (HDP) are associated with increased maternal and fetal risks. Doppler ultrasound indices of the umbilical artery have shown promise in predicting adverse fetal outcomes in HDP patients. This observational study investigated the correlation between abnormal umbilical artery Doppler indices and adverse fetal outcomes in HDP patients. Methodology Over a two-year period from2020 to 2022, in Acharya Vinoba Bhave Rural Hospital, central India, we enrolled 138 pregnant women with HDP beyond 28 weeks of gestation and singleton pregnancies. Comprehensive clinical assessments, laboratory investigations, and Doppler studies of the umbilical artery were performed. Doppler indices assessed included the systolic/diastolic (S/D) ratio, resistance index (RI), and pulsatility index (PI). Adverse fetal outcomes were defined based on birth weight and neonatal intensive care unit admissions. Chi-square or Fisher's exact test was used for analyzing the relationship between qualitative data, while an independent-sample t-test was employed for quantitative data. Results Abnormal umbilical artery Doppler indices, including an elevated S/D ratio, RI, and PI, demonstrated a positive correlation with adverse fetal outcomes in HDP patients. These findings highlight the significance of umbilical artery Doppler indices as reliable indicators for anticipating adverse fetal outcomes in HDP patients. Conclusions Abnormal Doppler indices in the umbilical artery, including an elevated S/D ratio, RI, and PI, appear to be valuable predictors for adverse fetal outcomes in patients with HDP. Monitoring these indices can aid in risk stratification and improve the management of pregnancies complicated by HDP.